Alexander P. Heckler - David Mancini & Sons, Inc. M[AM. 1 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 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 S�j activities. The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND AD RESS (Number and reet) (City) (State) (Zip Code)O&LLEL
C5365:_ 1 0!13_�4,TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY: C% _
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NAM YiNCIPAL/C I T:
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BUSINESS NAME AND ADDR (Number and Stre t) (City) State), (Zip Code
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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:
'
MSPECIFIC LOBBY ISSUE: -0AV 1 A Me cryi 60 Al S
Issue to be lobbied(Describe in detail):
III.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
title of person to be lobbied n
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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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%p—r-ersonally-Imown(LoDoyist) ------ – Personally known(Principal)
VII. SIGNATURE AN
o40°41 Notary Public State of Florida
-State of Florida Coun of ia: Thais Alexandra Asper q;
ty State of Florida,Count of I Aia
Sworn and subscribed b y Commission EE 099628 f state of Florida
cif fires o8/20/2015 Sworn and subscOgd b �lfe r is xandra Asper
Th' day of This da fl. N@@ ission EE 09%28
Expires te=12015
Sig ature_oTPup c tary—State of Florida Signatbre of Publ' Notary— tate of Florida
Notarization oT Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED Y CITY CLERK'S STAFF ONLY �J
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\a FORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc V� Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
/�A I AM I B EACH
City of Miami Beath, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk City(--lerk @miamibeachfl.gov
Tel: 305.673.741 1 ,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.
In addit once an issue I have registered to lobby on has been resolved, or I am no
longer b ing on that issue or for that principal, I am required to immediately notify
the Cit Cie 's Office of lobbyist withdrawal in writing.
Pursua t to action 2-4.85 (d), the City Clerk shall notify any lobbyist(or principal) who
falls to timel file a Statement and in addition to any other penalties which may be
impose as p vided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statem nt(s) sled a r the due date. The City Clerk shall notify the Miami-Dade
County ommll sion on Ethics nd Public Trust of the failure of a lobbyist(or principal)
to file th Sta ment or ay th ssessed fines after notification.
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Any lob ist, h fails to Me a required Statement by April 30th, 2012, shall be
automati ally ende from to being until all fines are paid, unless the fine has been
appealed o ami-D de C un Commission on Ethics and Public Trust.
Signature:—.,/ bate:
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