Eloisa E. Lopez-Gomez/Inffinito Foundation.m MIAN~IBEACH
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 331392009 ~Il}W 22 ~~ 9' 49
LOBBYIST REGISTRATION FORM ~ i7 ~ -- L ~-- `~'
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 lobbying activities. The term "Lobbyists" has speclflc exclusions. Please
refer to Ordinance 20043435. ~/~
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NAME OF LOBBYIST: (Last) (First) r (M.I)
/~/~t~l// Tb ~ y.y ~~~ Off/ ~ 2 3 ~'(/Gt J~ rl fD N 1~/' JVl ~C~~vt,~ ~'eGc~
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Slat (Zi' Code) 33I ~~
~~
I. LOBBYIST RETAINED BY:
~~
NAME OF PRINCIPAUCLIENT:
/,2.3 4a GcJ ~ s~-c..i' rt '~ ~ ~/.Q • ~l~,c C~~M 1 ~~C C'-~'J, 3 3 ~
BUSINESS NAME AND ADDRESS (Numbs and S ~g ~(~) (State) (Zip Code)
3~^ 6th 33~~ ~ FAX NUMBER. (Optional) EMAIL (Opttonal)
TELEPHONE NUMBER:
Fitt out this section if principal is a Corporation, Partnership or Trust [Section 2-482 {cp
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n:SPEC[FIC LOBBY'ISSUE
_ ,.. _
K-1~7`~- ~'Q~-t_Ltea 1~ r ~)')')
Issue to be lobbied (Describe in
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Ill. CIT~:AGEMCIES/INDIVIDUALS T.O Bf °L!0`BBIED: Pursuant to City Code Section 2~s2(g) include
a statement of the extent of~~y a usCess, rsonnel lsoumht tlo be iobbieda! furtherepursuant tolCity iCode Section 2-
appearance of an impropriety y ty Pe g
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.
IV• DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) ,~/
B) PRINCIPAL'S DISCLOSURE (OF
(Required).
TION):
:a,
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":
` ` present or oendina award for goods equipment or service?` u~ menl or services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
--- ~ ~a.o~~ n~ent H reement with the Ci ~
application for change of zoning mati designation or change to the Citv's Future Land Use
Manz
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.
reimbursement. .
V• SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of
VI• LOBBYIST IDENTIFICATION:
~'L.1~ L .
Produced IDS L /a?~ -X05-ir/ -~Q~_d
Form of Identification
PRINCIPAL IDENTIFICATION:
~roduced ID ~` ~ ~- ~ L /oI 'a45 ~~ .. ~~'- v
Form of identification
^ Personally known (Lobbyist) ^ Personally known (Prim
„~ NOTA~PEL ~~ ISABELSA7C,HELL
VII. SIGNATURE ANDS SATCHELL ~ _ MY COMMISSIONt•DD879N1
~x: ;. MY COMMISSION # DD 879&91 ~. ~: EXPIRES: April 13, 2013
"~F;'-'"0.~' Bonded 7hrv N P
State of Florida, County of Mia `4 EXPIRES: April 13, 2013 gg';;c,' aary ubiicundervaite~s
' BondedThruhotaryPubl'~cUndernri~Aa of Fiorida, County of
Sworn to and subscribed efor ""~~ nand subscribed before me
This a?o2 day of ~~iy~° , 2ppg This ~2 day of ~i~~L.' a° , 2009
Ck~~ caF~SO~~,.~Je-c__~ ~,
Sign ture of Public Notary -State of Fiorida Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature r
TO BE COMPLETED BY CITY C ERK'S STAFF ONLY /I~C/~- ~~O~l T
Annual Registration fee: [ Yes [ ] No Amount Paid $ C #
Lobbyist Registration Fo received and verified by: ~ Date Paid
F•\CLER\$ALL\ FORMS
a \LOBBYIST FORMS\Lobby~st Registration Form 21109.doc Revised 02/11/2009
~~ ~u~c~~nny swear mat ali of the foregoing facts are true and .correct and that I have read or am familiar with the
provisions contained in Secti~~-4$2 o{fie Miami Beach City Code and all reporting requirements.
P~^~IAMIgEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~G0~1
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-4$5 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.
Si re: Date:
C i tyC lerk@ m i a m i beach fl . g ov
l~ope~ ~ gOme~-
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc