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James R. MacKenzie/Pestana Miami LLC (3) k ~ ~~ ~ ~,, a ti ~ 5~ ~ °~ ~~~ 1 } ;' v ~'~ ,' ~ ~~~~ ~ ~ ~ff~ce of the City ~~~ 33139 ~~~ ~ ~ ' .t Of nluami Bea~hprive, Mjami Beach' '~ C nVention Cente GISTRATION FARM a the Passage. defeat or modificbao oa o~ er or any city ~~ LpgBY~ST RE al who seeks to encoura9 a City Mana9 rpGess on such a princip endation of g' aking P The term a1d or not, by Beason, recom hod of the entire decision-m nlmitlee, please action, the Ume P® city board or rA W~ or retained, whether 1gs~oner; any onnel during the city commission, ° rsts" has spec~ic exclusions. mP ecr~n of a ,on of any city Pew by Lobby er5o~ tto~ or d r wryl be heard or reviewed ctivit1es. The term n a\\ P rod \~on °r tr9 eseeably engaged in lobbyi~ ~ K . S (M.I) Loppyrst~n n~ my a~ ro~naa~ as w~~ any emPlo~ //~~ an m~i~ltee,c S,on of <e°dr~ `trA35• n est (First) ~~ ~~ Sot~cdr~\o `,na ae2 a(Last) f~ .S' ~ (Zip Code) o d / (State) / ~ ,, ,, ~ refe<< r/ ,_ / Lam' ©.'_.~ (City) ~' ~. ., ._ ,.~'-IP~~~~ (Number ano ~~~~°•~ JF CHIEF OFFICER, PARTNER, OR ~C'~`~ "'° R INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN ,TIFY APO~R pNN pARTNERSHDP OR TRUST: Z ~~ include pursuant to City Code Section 2-482r9se to an Je I bled (Describe in detail): E L.~BB~E~, iving S TO ~ familial, professional or other urea ant toi City Code Section 2- pGENC1ES~~N~NIDUAL financial, further, p receding said City ~ business, ht to be lobbied aid from 12 months p ro riety with any City pe~Onnel soug aid or unp ), the general nature of the subject statement of the extent of any contractual relationship resent date, stating appearance of an imyptatement of any to the p 482(ax4) include a personnels' commencement of service `"nth the C y contractual relation. B) pny Financial, Familial or Professional Relationship N Ong ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ O A ~ , ~ ~+- ~~~~II ~~' ,, GF"c,~ CO P/7 S~G~-c~,~ ~„ 1 `C B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPE AT N '/ - (Required). -~tp The following information must be answered: J 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ~ \ present or pending award for goods. equipment or service 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": application for change of zoning map desianation or change to the City'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 section but, shall not be required to pay any registration fees. ^ YesTNo• Are you representing anot-for-profit corporation or entity without special compensation or ' reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE P E'f1EDING E YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT R S O QO SATION DURING THE REPORTING PERIOD. Lobbyist I do solemnly swear that of provisions contained in Se~tion Signature of Lobbyist: Signature of Principal/Clievit: ~I VI. LOBBYIST IDENTIFICATION: ^ Produced ID ~, ~ Form of Identification L~Personally npigdp'~t.obbvis ai a ~e cc e and correct and that I have read or am familiar with the City Code and all reporting requirements. ~' `c+'s Notary Publk - State of Fbrida VII. SIGNATU F~ 'Ei~tbl~~,q~ 4, 2009 ':~ ~ F~d;~- Commission # DD458380 State of Florida, Co mi~s}ByNationalNotaryAssn. Sworn to and subscribed a ore m This / ~- day of ~, 2009 Sigii~-furs of Public Notary -State of Pf'orida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: a ~ Produced ID Form f de tification ,,~ ti;;tr P~B~ ,,- JULIA FERNANDEZ ~P"ersonally known ( ~, NotaryPublic-StateofFlorida • ' My Commission Expires Aug 42009 ~~%'~ os F~- Commission # DD4583ti0 """" Bonded By National Notary Assn. State of Florida, County of Miami-Dade Sworn and subscribed before me This day of K , 2009 Signa ure o Public Notary -State of rida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ Yes [ j No Amount Paid $ Op MCR ~~,~~~- - Lobbyist Registration Form received and verified by: r:~~S ',~~[.~.=,,~r~~E~ jLZ3'~~~'~` ~~b~ : ~eistratiar~ ta~~a-i ~.1Cla~ Paid Revised ~ 4 Js, 1 l~,~tlr V'~; ~ 'w~., s~~ City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fox: 305.673.7254 CiyClerk@miomi beachfl.gov LOBBYIST NAME: ~~ N.~.I~ I understand that no later than October 1st of each near, 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 an 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. ~ 2 D e: {~evisacJ 02/04/2006