Stuart P. Rose/U.S. Legal Services~~('g/9 ~ c,`~
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 mod cation 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 specific exclusions. Please
refer to OMinance 20043435.
- Rose Stuart P
NAME OF LOBBYIST: (Last) (First} (M.I)
1417 Venetian Way, Miami, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-6263 305-372-5777 StuartPRose@aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
U.S. Leal Services, Inc.
NAME OF PRINCIPAUCLIENT:
8133 Baymeadows Way, Jacksonville; FL 32256
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_9nL~-IaL~R-h000 904-730-0023 mforLes@uslprotects.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Marie M. Forbes, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: Marie M. Forbes
II.SPECIFIC LOBBY ISSUE:
SP~tPmhPr 9, 2009 Item C7FF/Benefits
Issue to be lobbied (Describe in detail):
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(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 TiNe B) An Financial, Familial or Professional Relationship
Ma or and Commission None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: Required)
No compensation ~or specific issues
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). NO compensation for specific issues
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 ^ No: Are you lobbying on a present or pending bid for goods. equipment or services. or on a
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":
^ Yes ~ No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance 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.
^ Yes ~XNO: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of th foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Sectio 82 of e ~ ch City Code and all reporting requirements.
Signature of Lobbyist.
Signature of Principal! lient: ~ ~t~.~'~. - e
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LOBBYIST IDENTIFICATION:
duced ID ~~ao ~Q~C(~, /d?I U
Form of Identification
known (Lobbyist)
TURE AND STAMP OF NOTARY:
~~~rrt~llllti~trtit~ of Florida, County of Miami-Dade
Sworn to and subscribe bef~o-r-eLm~e
This??~~day of ~~~~~e'nr`"`y2009
iZ(~C.cPiJ-n~i w
Signature of Public Notary - Sta of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
~ Produced ID
,,_,/ Form of Identification
C1 Personally known (P n n a. Notary Public State of Florida
Julienne Joyce Bellamy
~; _, Pa My Commission DD781758
''F'of~,o~ Expires 03/05/2012
State of Florida, Co ty of Miami-Dade
Sworn ~ryd subscri d be re me
his day o ~ , 200
~~
ignature of Publ' ota - Sta of Florida
Notarization of mci al's si ature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes ( ] No Amount ~ai~ f~ "' MCR # Date Paid
Lobbyist Registration Form received and verified by:
F.\CLER\$A~L\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.doc Revised 02/11/2009
PERIOD.
Signature of Lobbyist
m
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeochfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~~ U ~ ~d Se
I understand that no later than October 1st of each year, 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.
Signature: Date:
F:ICLERILOBBYISTILobbyist Registration Form 32748.doc