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Timothy G. Dupont-Stinedurfm MIAMIBEACH `~- ~'~1~ ~~r1 r'~( 1-c2 ~_ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in l'o`bbying activities. The teen "Lobbyists" has speclflc exclusions. Please refer to Ordinance 20043435. Q u ~ ~ ~ "j -' ~7) Iv l:_. ~ u t~ttPo~n - ~Z t~ 7w-~t~-~ y !,-. NAME OF LOBBYIST: (Last) (First) ~L.~LE (M.I) 81.E-~ , ~- p~:StG~-~ C°yMy~-"1 ~ ~,--L. , 3(a7c7 N~ MtA+w I ?t/t~, y-'L-A+~^i ~ t'z-- 3313 BUrrSINESS NAME AND ADDRESS /(Number and Street) (City) (State) (Zip Code) l3us' 'S3-' fB``a~ (3~5~ 53~- ~rssh 7tr~e Bu~EO~~i~4~r~tnw-`1. Gwt. TELEPHONE NUMBER: FAX NUMBER: EMAIL: I.pp LOBBYIST RETAINED BY: NAME O PRINCIPAUCLIENT: 61,''E, A AE1511,~ Gu~r~ ~ f~ ~ 3 [m~y ~ M~Arh l O~ f /-1 fAr+ l l E r_. 33 t3~ BU i SS NAME AND ADDRESS (umbej an Street) (City) (State) (Zip Code) ~3os osbt- ~L~ti iL~S~ 53t' ft5~~ 7Mt Q i3t,.+~,or's.StuJ~o,„pN~'S• (n TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Ootionall Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: 71~^'+o7N`j (~ P~7(~t1fr1- S?,~at,~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ,Mn G. AvP~nn- ~?,N6QuR~ nSPECIFIC LaBBY ISSUE; pas-(,tJ R~(cut~ &~~ . ~ G~.7"~~lu-( vim, /V-f4r'•t 1~-~4 - /~IP~L. o~~ a~(~°I Issue to be lobbied (Describe in detai iii. CITY A~EN~IES/INDIVIDUALS T.O BE `LOSBIEID: Pursuant to City Code Section 2~82(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an appearance of an .impropriety with any City personnel sought to be lobbied -further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ ~~~ ~ /~S r- B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST C MPENSA ION • E ~~"°"_l ,~; ~I Q ~, (Required). d ~"""' -! The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes 'dXi No: Are you lobbvina on a aresent or pending bid for poods eauipment or services or on a present or pendina award for poods eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ~ No: Are you lobbvina on a oendinq application for a Development Agreement with the City or application for chanae of zoning map designation or chanae to the Citv's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this `,s.~ection but, shall not be required to pay any registration fees. ^ Yes ~J No: Are you rearesenting snot-for-profit corporation or entity without saecial comuensation or reimbursement. . V. SIGNATURE UNDER OATH: nu nnr~~re~ .ST ,.~ r.....~ ..~ PERIOD. re of I do solemnly swear that all of the foregoing f c are true provisions contained in Section 2-482 of the i ea Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ~ / ~ P d d ID ~'~ ^~~^ ro uce Form of Identifi ~o ~? ~ ^ Personally known (Lobbyist) g ~ _~~;~ ~~~~ VII. SIGNATURE AND STAMP OF NO • Y ~"~ W State of Florida, County of Miami-Dade ~ m Sworn to and subscribed before me '«'~o.,, This o~ ~f ~~ da~f,of ~~-f2,u„~,,,, .2009 ,~~~z of Lobbyist's s of Florida and that I have reed or am familiar with the all reporting requireme,~ts. PRI~IPAL IDENTIFICATION: \ / ~oduced ID ~~ (~~"'~ Form of Identification ~, ~ '~ :~ ~~ ~ , ~T~ ^ Personally known (Principal) i t.~~~ W~' y -,~~~' F 4= •~ Y^ c1F ~~ > W State of Florida, County of Miami-Dade ?s °C z Sworn and subscribed before me '` ~ W ~ This ~~day of .2009 ~ ~- a •''~ "°~, ''~ Signature blic Notary - tate of Flor - Notarization of Pn sip ture ~"'-~~ TO BE COMPLETED BY CITY C ERK'S STAFF ONLY Annual Registration fee: ]Yes [ ] No Amount Paid $ ~" MC Date Paid ~~ Lobbyist Registration Form received and verified by: F:\CLER\SALL\aFORMS~LOBSYIST FORMS\Lohbyist Registration Form 21104.doc R@Vlsed 02/11/2009 ~..~ City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, www,miomibeachfl.gov CITY CLERK Office CiyClerk@miamibeochfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: 7~n7µ~ G. Avo~N~- ~5-7it~tl~S I understand that no later than October 1st of each xear, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once on issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Signature: -~ a~ Date: r~evisaca a~,oa~zoos 'o a d '' o =_ y C a ~ ~ ~ ~ z C ~ \ (~, V © ~ ~ m ~ n ; r ,~ v ~. m N n ~_ ~~ ~~ ~ ~ 0 3c t~ ~ n C7 y _ ? .rt .;_n r'; , ~n ~_ t•_, ~- ~~~ is v 0 Z N F._ y~ ~-°~ `-0! r_ry