Steven V. Boucher - Boucher Brothers Management ,- , A,/ , ‘ 1 /,,, f ,,, /0 D E i. c H
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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
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 specific exclusions. Please refer to Ordinance 2004 -3435 /
- 7›ottakie Sk_eo_
NAME OF LOBBYIST (Last) ,/ (First) ,,��// (M.I)
7wtke( BrMMJ'JAY," 1 % C(lo /„ 7I / m, 40 1C'L ?3,3
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3 S'35- $ I ? 3o5 53'- 3 a R8' 5 vfLouckeK 2@ apta I •6m1
TELEPHONE NUMBER. FAX NUMBER: EMAIL. V
Please notify this office if your contact information changes:.address, phone, or e-mail a ddress.
I. LOBBYIST RETAINED BY.
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NAME OF PRINCIPAL/CLIENT
4 , 2 - 0 Grit e / c WI/ ?c,r Am, &&f/ FL ,3 3/34
BUSINESS NAME AND ADDRESS (Number and Street) (City) ( taS te) (Zip Code)
3o5- 53C C 7-7 3eS s' 524 5ii g Au MeloI t . •r sti•
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL. (Optional) , )
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Fill out this section if principal is a Corporation, Partnership' or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY 1.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST '
II:SPECIFICILOBB'Y ISSUE, _,)
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Issue to be lobbied (Describe in detail):
III. CITY. AG.ENC:IES /INDIVIDU.ALS "TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include 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 the present date, stating the general nature of the subject contractual relationship.
Sec 2 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES I
title of person to be lobbied / X
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Pursivant`•to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any bu nee I,fa t�Y`professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current cl0..bOi,t issioner or city personnel who is
sou • ht to be lobbied as identified on the lobb ist re• istration form filed. 1
Sec 2- 482(g) Any Financial, Familial or Professional Relationship 1 : " "
Y . _ i A i :4 1 3 1 8
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR 1
OTHER)•
A. LOBBYIST DISCLOSURE (Required) "ft. 0 lv L �/ !
Si PRINCIPAL S DISCLOSURE (OF LOBBYIST COMPENSA 'N
(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"
— es ❑ 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 -4 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues"
t `
Yes o. Are you lobbying on a pending application fora 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 B City Code 2 -484 (h) Any p erson (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, s II register with the clerk as required by this section but, shall not be required to pay any registration fees
Li Yes 7 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.
Scgr,at,;ri„
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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 2-482 of the Miami Beach City Code and all reporting requirements
Signature :z:iciient
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Signature : /�
VI. LOBBYIST ' IDENTIFICATI O N Y ' ' , 4 ` ' PRIN IDENTIFICATION'
Produced ID J Produced ID
Form of Identification Form of Identification
�� '���\� \MAN ./0/
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i
I Personally known (Lobbyist) ❑Personally known (Principal ••F9G� i
� . �COMM/S r^
;•� pp • VII SIGNATURE AND STAMP OF NOTARY CAROUNA -- :.--•:: 0 # o� 'Z2`4%-45";-
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•B / TESIL`L0 n
State otFlorida d subs ribyd of beyform Dade „. c_i * EXPIRES: arch 2P 2014 Tate of = lorida,;County of Mi • y 'W O r �. \
A Sworn d subscribed before
Th da of ZU 'E�r�o� BondedThruBudgetNaary Services This da .f �I�, P
"" "111 i ; T ... • •Q�'�O
E OF F\-,. \\\ •
Signature of Pu is Notary - State of Florida rg' ature of PublieW otary - State of Flon. a
Notarization of obbyist's signature Notarization of Principal's signature
7 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY n
Annual Registration fee [ } Yes [ } No Amount Paid $ S ,- MCR # O/ Date Paid P-
Y 9
Lobbyist Registration Form received and verified by 1�P / -
F• \c ER\ ;ALL \aFORMS \LOSS "IST FORMS\Laoovis Annual Registration Forn:.dio: *PPi r' ' Revised 1/11/2011
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. ck u { 1^ Ou C/
I understand that no later than February 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 and 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.
1 2/3- 1
Signature: :Date: