Kate Williamsi f ~ 9
m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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Lobbyist means all persons employed or retained, whether paid or not, by a princpal 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 aty commission, or a city board or committee. The term
specifically inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
IvHnnt~~r ~W fjts rtS f : (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) ( ate) ,Zip Cod
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TELEPHONE NUMBER: FAX NUMBER: {~ EMAIL: ~j ,
I. LOBBYIST RETAINED BY: ~a' -v ~~' ° -~1 ~~ ~~ ~~ v rg
NAME OF PRINCIPA CLIENT:
1 sa. i F;~c~ra,~ 12~ ~- i 17 rn ran r, P~~c+l ~i-- 33 13 ~i
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
UMBER: FAX NUMBER: (Optional) E
s~ t~ ~-~ ~~ f3 a 3c~~ s~ ~ a ~ ~ 3 I~
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out this section if principal is a Corporation, Partnership or Trust [Section 282 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~~ S~C~I-E-~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE:
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 raise 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 the
commencement of service of City personnel to be lobbied.)
or
h 0 ~ 11 ~~ 0 ~ ~-~0 60~Z
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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 LOBBYIST COMPENSATION):
(Required).
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 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 designation or change to the Citv's Future Land Use
Mao?
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 Principal/Client: _ Olrt.a,.~ A~C,L~~.~'.~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF ~1`f~`jf:
State of Florida, County of Mia ~Le~~e a~a~p~~h~~~
Sworn to and subscribed b ~14i~en°e,,~~ss~9\Zp~~
This ,~2~ day of ~'aao6dl.~~Z
Sigr~ture of Public ot~, of
Notarization of Lob is ' ignatui
TO BE COMPLETED BY
Annual Registration fee: [ Yes [ ] No Amount Paid $
Lobbyist Registration Form received and verified by:
F;\CLER\LOBBYI5T\Lobbyist Registration Form 32708.dot
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
~~ersonally known (Principal)
State of Florida, County of
Swom and subscribed b
This day of
vu
0
i ture of b~
Notarization o P~TRd
LERK'S STAFF ONLY
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e of Florida
signature
_Date Paid
Revised 03/27/2008
~o' f ~O le _ ~~Dyf!
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 282 of the Miami Beach CitYCode and all reporting requirements.
' r
m MIAM'[3EACi-!
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK OfFice CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: ~-~t S
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 j 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.
Gam- ~~l c~/I~ Zg o
Signature: Date:
F:\CLER\LOBBYIST\l.obbyist Registration Form 32708.doc