Neil Flaxman - 1st Class Vacation Properties:m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
S ~oR~ ~2t~ ~~~~
Q-
LOBBYIST REGISTRATION FORM i r-~
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or~i~odifi~n of•
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or any City bbard or ^~
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process a~Such 1 '~
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committ@e? The,,r-^t~erm ;e""~
specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclu~ns. Please
refer to Ordinance 2004-3435. ITS `~~
1 ~" „.-~.
NAME OF LOBBYIST: (Last) (First) (M.I) ~ ~ `~; ~~
~a~\ F\c~+rnc,n, Q.~ . , ~ Sv,~ '~ S=rre ~ S.>;~-~ 3~0~, m~C,rn~-~~~33~
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip ~dde) C~
.-~,
~S - ~~ 0• ~1~n 30S - 81~- a~`~f ~~axy c~ i~el 1S~~1R . n~--
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:_
,1~~C~ ~ ~~~fl~ ~t~,r~Cl~ s
t3U ' tSS AME AND~DDRESS (Nutnber_and Street) (City (State (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Option I)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
._.... ..
rt~~l.~~~ C'S'C 1~
O ~-t~~
III. 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
personnel' commencement of service with the City to the present date, stating the general nature of the subject
contractual relation.
A Full Nam
e
of Individual Title B) An Financial, Familial or Professional Relationship
~
^~
~~ ~-('~-J l lC t `~PC~I ~ n
I
5P
- ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
,F RATE OR OTHER): ~;~(,~ p---~~ 1 ~ q~
.- =A) LOBBYIST DISCLOSURE: (Required) ~ "" "' O ~ ~~ v '~9~,, Y w~'~/
Y' ~
B) PRINCIPAL'S DISCkQ/5U~E (OF LOBBYIST COMPENSATION):
(Required). Ala ~ ~~~~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
application for change of zoning map designation or chance 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
section b~~shall not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Clie
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida; County of Miami-Dade
Swnro land c ihGrriharl hafr,~t'e me ~
re
PRINCIPAL IDENTIFICATION:
~,~
L~'Produced ID ~~(. afw4~ ~.,~, ~ ~'LZ.3`~`~~Q'" 1 l -~~6~-b
Form of Identification
^ Personally known (Pri c' P~R~~
~.: :,s MY COMMISSION # DD 803661 _
'-~' EXPIRES: July 23, 2012
' jjf Bonded itw Notary PubBc lMdarwtltaro
State of Florida, County of iami-
Sworn and subscribgd before me
~$ 4.~ day of.~.1LJv~,P .,201
\Signature of Public Notary -State i~f~ ri a
otarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes [ ] No Amount Paid $ 0 ~ MC~# ~E~i ?j~TDate Paid /U
Lobbyist Registration Form received and verified by: _~aSAbP ~ ._ (1.A
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc Revised 05/05/2010
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
I do solemnly swear that all o~'~ foreg g fact are true and correct and that I have read or am familiar with the
provisions contained in Secti 82 o e Beach City Code and all reporting requirements.
~. ; -~ ~
f~ ~ _ s•- ~
-City of MiamiBeach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CilyClerk@miamibeachfl.gov
Tef: 305.673.7411 ,.Fax: 305:673.7254
- ~ Acknowledgement of fines/suspension from lobbying for failure to
- comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: ~~~ 'F'~O,x~rn~,n
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures,. as well as compensation received, for the preceding
calendar. year with .regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures- or
compensation during the reporting .,period. The statement shall list, in detail, each
expenditure by ..category, including food and beverage, entertainment, research,
communication, media advertising; publications, travel, lodging and special events.
Failure to timely #ile .the expenditure and fee disclosure report will result
in a fine of $50.00 per day. Any lobbyist who fails to file the required
expenditure report by December 1, shalt automatically be suspended
from lobbying unfit all fines are paid, unless the fine has been appealed
to the Miami-Dade County Commission on Ethics and Public Trust. In the
event a lobbyist fails to ei#her file the report and/or pay the assessed fines, the Clerk shall
notify the Miami Dade County Commission on Ethics and Public Trust. -
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 welting.
Signature:
~~
Dat .