Lee Brian Schrager - FIU bi P 4 L/
MIAMI V Xv'j �
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 W
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.
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NAME OF LOBBYIST:
S O V G V h (Last))1 (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
30S -1025-V71 X 1040 UY-bZ4.1102 I rA 6 CA nog.r ;Dsov411c ;hC.-cd04
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. �LOBBYIST RETAINED BY:
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NAME OF PRINCIPALICLIENT: ff
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BUST ESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
05.. 621- 12.fo $05-I#Vt- 11.02.
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:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied(De Wbe in detail):
ill.CITY AGENCIES/INDIVIDUALS 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 eneral nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
1 title of person to be lobbied
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Pursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482 Any Financial,Familial or Professional Relationship
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Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
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B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): J
(REQUIRED). X� ho AVW;'+'1-oH tA 1 Cowlet vt Sot 4,10 y4
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 2�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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes W_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 Section 2-482(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 cleric as required by this section but,shall not be required to pay any registration fees.
)CYes No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WE LL AS COMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMEW SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD
ilegrgfure of Lobbyist
I do solemnly swear tha all f 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 'a Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Clien .
VI. LOBBYIST IDENTIFIC N: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Notary Public State of Florida
/Personally known(Lobbyist) Personally kno T()Patricia M Tully My Commission DD900207 VII. SIGNATURE AND STAMP Expires 08/29/2013
State of Florida,Count of Miami-Dad :4�r 0� Notary Public State of Florida State of Florida,County of Miami-Dade
County 0 % Patricia M Tully
Swom to and subscribed bef re me ,� My Commission DD900207 Sworn and subscribed before me
TtA day of ,20 ?o�aa1 Expires 08/29/2013 This 62day of ,2012
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Signature of Public Notary—State of FI rida Signature of Public Notary—State of Floridif
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid; MCR 8 Date Paid
Lobbyist Registration Form received and verified by:
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Formrevised 5-30-2012.doc