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Lynn M. Dannheisser - Adam Sander n qb MIAMI BEACH 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 foresseably 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. he term '1 j"Lobbyists"has specific exclusions. Please refer to Ordinance 20043435. n NAME OF LOBBYIST: (Last) (First) (M.I) K)_ 6 r 3 BUSI ESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip C de) fir) YLI I a 3'�' 3 S 7- O 5 L- ti,.!ZG CL,1k.,_6d9 &C_1924 - 6X&I TELEPHONE NUMBER: FAX NUMBER: E . Please notify this office If your contact lnfonnatlon changes:address,phone,or e-mall address. 1. gLOBBYIST RETAINED BY: NAME OF PRINCIPAVCLIENT: a 3 31 yc-� BUSINESS NAME AND ADDRESS (Number and Street) ( ) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optlonal) Fill out this soction if principal is a Corporation,Partnership or Trust(Section 2482(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: t1.SPECIFIC LOBBY ISSUE: ava r GLS c Issue to dolobbled(Describe in detail): . IIL CiTrAGENCIES/INQIVIDUALS TO'BE LOBBIED: 3 to L 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. Sac 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied i 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 Plod. Sec 2-482 Any Financial,Familial or Professional Relationship C:lUserslderhalAAppDatalLoca Microsoft%Windows%Temporary Internet FlleslContenl.Outlookl63LGODDH1Lobbyist Registration Fomnrevlsed 5-30-2012.doc Q c. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 4;Y 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": _Yes X: 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 Xo: 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 2481 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 : 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 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. Sig o Lobbyist I do solemnly swear that all of the for oin its are true d correct and that I have read or am familiar with the provisions contained in Section 2482 of the Miam B ity o and all r orting requirements. Signature of Lobbyist- Signature of Principal/Client: _ VI. LOBBYIST IDENTIFICA 10 PRINCIPAL IDENTIFICATION: Produced ID , �� 5 J �? �� Jproduced ID FL tA. • SS Form of Identification Form of Identification Personally known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn to Asubycrib�rLVIK20 Sworn a d subscribed before me This ° ""�da of T ' da 2eq Si nature f Public Notary—State of Florida of P Notary—State of Florida N tarizati n of Lobbyist's signature otarizati f Principal's signature TO BE COMPLETE CITY CLERK'S STAFF ONLY An Registration fee:. [ ]Yes[ ]No Amount Pald$ MCR# Date Paid I" Lobbyist Registration Form received and verified by: _ C:\Use mporary Internet Files\Content.Outlook183LGODDH\Lobbyist Registration Formrev 2.doc -eaMa a, ' `,%�Pnv P�e'� M4RCEL0 LEUS - my ca". VVAM Notary Public-State of Florida c -•-EE =•. . •; •.' p�� - My Comm.Expires Jul 31,2014 � 1111 VWWOY ntra�liIrtli�otu�, :�9f p�` ��iFOFF�� Commission #DD 995267 ��I11I %% listration rorm.dac Revised 04/27/2012 BP00, A �, r i City of Miami Beach, 1700 Convention Center Drive,Miami Boach,Florida 33139,www.miamibeachil.gov CITY CLERK Office Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: I understand that no later than February 28 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. a In addition, once an issue I have registered to lobby on has been resolved, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d),the City Clerk shall notify any lobbyist(or principal)who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1,a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. XKAf rll _� Si OaYu re: Date: i C:\Users\clerhall\AppData\LncalX.Micrt)solft\\Aflnitm4t\Temporary Internet Files\Content.Outlook183LGQDDHILobbyist Registration Formrevised 5-30-2012.doc I a ram „ -_s { - r �. A _ ic m. m o o, CL- •I (�\) pCb rr ic .� Or y FL CD p _" `. �. ;h{4 VN a 4 _ _ = o Lynn M. Dannheisser, LLC Page 1 of 2 Call Toll Free:800-620-0900 (7,'( ts Info for Lawyers LOGIN e,r1 W Y a: I r I` R C:, 11 t X 1' 1:K? ,s r Home Advanced Search Legal Articles Settlements Blog Saved Lists For Lawyers Home>Lynn M.Dannheisser.LLC at Miami.Florida r � Lynn M. Dannheisser, LLC Find A Lawyer Practice Area c Please Select Basic Info Contact Map&Direction More Info Where: Name: Lynn M.Dannheisser,LLC Is this your firm? _ ••._••• --_. -._•• -•---_-_•—" Practice In: Government,Real Estate,Mediation,Dispute Resolution Upgrade to a premium listing. Location: 3152 Gifford Ln Save to List Search Advanced Search Miami,FL 33133 Directions ) Birr r G.aril VJay Recent Legal Articles Phone:305-441-0222 I. ! a r Fax:305-397-0955 lCal Attorney: Lynn Dannheisser 'k Introduction to Probate Court in Illinois Coral This article provides a brief summary of the probate Firm Size: 2 to 5 GatiiPS and guardianship court in Illinois. by Kevin Williams Accident&Injury Cases !., www.vicLimaid.com L'` Finalizing Your Divorce Call Accident Victim's Rights Attorney Jason Discussion about different matters which should be Turchin today! addressed at the conclusion of your divorce case. by Lisa Zahn Social S e C U I i ty What Are Interim Attorney's Fees? 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Bryant Law Firm Lawyer.com Featured Elder Law,Estate Planning,Litigation,Car Accident,Health Care Save to List 2701 S.Bayshore Drive,Suite 606,Coconut Grove Bank Building Miami,FL 33133 _ ......... ... .. _.....,_,,. - .-,......_.. ..... ........ ..........,...... ..... ._. Hollander and Associates,LLC Lawyer.corn Featured Lawsuit&Dispute,Business,Consumer Rights,Divorce&Family Law,Wills&Probate Save to List 2 South Biscayne Boulevard,Ste.1650 Miami,FL 33131 Alvarez&Rodriquez LLC Lawyer.com Featured Admiralty&Maritime,Personal Injury,Workers'Compensation Save to List http://www.lawyer.com/firm/lynn-m-dannheisser-llc.html 10/3/2013