Joseph F. Blitstein - Elmer Figueroa r r
t-s Al D t...\: C O ° ° 0 PS
C ty of Miami Beach Office of the City Clerk
1700 Co nventioi 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 passage, defeat or
p y p p to encourage the assa
Y P 9 p 9
modification of any ordinance, resolutio , 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 committe-. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The ter "Lobbyists" has s • - cific exclusions. Please refer to Ordinance 2004 -3435.
.b) 1 fei A c�GS -ei _,
NAME OF LOBBYIST (Last) (First) (M.1)
T . 6 Cons t� 1 1121 Ca \o- w-ki Q 4' tz 6 6. , ' ' 31
USINESS NAME AND ADD S Number anc Street) (City) / (Stat // (Zip Code)
365' 3(t `106 - 6' " .�,S1-c.2h' 1E (S _ ec. et - scz0 , C'
TELEPHONE NUMBER FAX NUMBER: �' - `EMAIL:
Please notify this office if your co tact information changes: address, phone, or e-mail address.
1. LOBBYIST RETAINED BY:
Et 1
e CI 0 tk_ii 0 4_ / S \ 0._ t. et-ri■-% l7i \ (\r-4 1 `Q. OLP(‘-Ce
NAME OF PRINCIPAUCLIENT: CJ
Lj-600 n _ , o V-(( )2 L 33 V '�)
BUSINESS NAME AND ADDR S (N mber and Street) (City) (State) (Zip Code)
. -v ' 3 ° 7a < `
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corpora ion, 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.SPEC1F C LOBBY ISSUE' 0, Li &,o 0 . (- ")6 Ro , ,m, B. 3 3 1,*
t AO_ \oce,,,V „A 42- it ' c., ,,,,V e. kft,,, 1 \oc3A- „Lc:V._
Issue to be lobbied (Describe in detail): J
f
iii. ( AGENCIES /INDIVIDU LS TO SE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) i clude the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to t e present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of 1 dividual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
( t \ k e . J A ) M e)
1
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to stateltpg gg x f sjn s ancial, familial or professional
y W
relationship, or other relationship giving rise to an appearance of an improprietit`th' a utt cb sioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship QS :Z lid 1 - ThF 11111
\e (.%
y
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
7 Ay f}e
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION) , (-7
(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 ":
❑ 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
� Dev ve elopment Issues ":
❑ Yes 1 No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation 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 a not - 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 . X / No: Are you representing a not -for- profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of .b.y j
I do solemnly swear that all of the foregoing facts are true and c•, •= ., and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami Beach City C■d- and all reportin: ( - iirements.
Signature of Lobbyist: ■A /,!
dirt f
Signature of Principal /Client: -4-
VI. LOBBYIST IDENTIFICATION: f PRINCIPAL IDENTIFICATION:
Produced ID PA. C cAS c Ll Produced ID
Form of Identification Form of Identification
8 4^ 3 2 -L k - VG - (1-`f - 122-
kii-Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade 4,..... State of Florida, County of Miami -Dade
Sworn t• ..d subscri• -d before me PAULA ROCHA . Sworn a) subscribed before me
^ L� G Cumm# DD09017 his of
This �%fi d A a
of 1 t++"" ��. day ,, n 2011
Y C'-
rrr�)��� 40' 3 Expires 6/22/201 r
�t l m J vvv' s 4 .. At AiLl o
re of Pub ic' . to - State of Florida ;); Florida No te w r- o � Public Notary - State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
�,� TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
res
Annual Registration fee: [ N" [ ] No Amount Paid $ MCR # Date Paid 7 / — 1 /
Lobbyist Registration Form received and verified by:
F: \CLER \$ALL \aFORMS \LOBBYIST FORMa\Lobbyist Annua? RegitrIta Revised 1 /11/2011 ,
f -
•
M AM I BEAC
a
City of Miami Beach, 1700 Convention Ce ter Drive, M ami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: % d 4 I t + 4 (t,
I understand that no ater than ebruary 28th of each year, I must file the following form, 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 an. Compensation 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.
111
Signature: C Dat-: