Maria E. Fernandez - Chisholm Prop. So. Bch Inc. ,, 040
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• City of Miami Beach Office of the City Clerk
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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"Lobby'sts" has specific exclusions. Please�refer to Ordinance 2004-343
A� ArziA �.
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NAME OF L9.BBYIST: (Last) (First) ' (M.I)
t e l e* FOK-NA1-119 Pt0 14 — , 106. (L,,.2 N `'ErIIt ' kJecfaI i15 332 S t
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
RaGrZ, T. 'ea 12r (-re , RI es.
N��vI E OF PRINCIPAUCLIEN �I
CGhISI'btfn `PCO,�• O. S3ca■ GI( _ I�/ UR I( nee_ e �L 3313.1
BUSINESS NAME AND ADDRESS (Number and Street) (City" (State) (Zip Code)
20� -77f 28o5 2 3 f 1-3
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: RI r `' 6r -J W:e--8
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%O MORE OWNER P INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: 13CCe:r- L'ZEA r--e_ OO b
LOS:tit UE
Va-ial Q 0 e to !
•
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):4 A) LOBBYIST DISCLOSURE:(Required) . .. .70, - e 0,
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ,�J yi�if1. 00
(REQUIRED). V /"fit/
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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
YesXNo: 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 clerk as required by this section but, shall not be required to pay any registration fees.
_Yes;XNo: 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 A COMPENSA PION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH LL FILED 'VEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. -------
I
Sig ature of o.byist
I do solemnly swear that all of; e foreg% -; acts are true and correc -nd - I have read or- familiar with the provisions contained
in Section 2-482 of the Mia 'each CO'o,e and all reporting requirements. —
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`
Signature of Lobbyist: 'l l` ►:� A _
Signature of Principal/Client: _' ////� Wr�1���9 VI. LOBBYIST IDENTIFICATI Milrli/ ', PRINCIPAL IDENTIFICATION:
Produced ID T(CriCA... C , tl/�Y5 LL ° Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) �'P ° V Personally known(Principal)
Y ( Y ) x Nelms Y
VII. SIGNATURE AND STAMP OF NOTARY: ® 0
State of Florida, County of Miami-Dade t z.s a'`a. State of Florida,County of Miami-Dade
Sworn to and subscribed befor-.me ..0 .. Sworn and subscribed before me
Th.: . Sr' day of I1 h 1 01.S 2 E E This Zi) •=Y o , 201
-�a U $ _ 4 j , " k , DanielR.Hvff
_ COMMISSION FF151011
Sig ure of Public Notary—State of Florida �y-°�w, Signature of Public Nota ili *e t;i:.loaf
otarization of Lobbyist's signature Q4°�,_ r Notarization of Principal's sl,,;:i•'70%-,'tea EXPIRES:Aug. 14, 2018•
i�L/`�(I q q,•i'��`` www.AARONNOTARY.000
TO BE C MIS,`•,-,-,7n. B` CITVLERK'S STAFF ONLY I
Annual Registration fee: [ Yes[ ]No Amount ', id - MCR# 02-'60 U Date Paid 4I a(r.5
Lobbyist Registration Form received and verified by: —�L
F:\CLER\;ALL\a FORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office -
Rafael E. Granada, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 , Fax:305.673.7254
traViAcia
LOBBYIST NAME: stiA1016(' /'
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 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 lobbyi , w o fails to file the required Statement by April 30th of each year, shall be
automati Ily su,pe •ed from lobbying until all fines are paid, unless the fine has been
appeal, ••' o the is i-Dade County Commission on Ethics and Public Trust.
ii 111116/ Au ' '7# I4
Signatu e: I . • Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach-Florida
Finance Department
1 City Hall
1509120-1 04/01/2015 BR1 T121
Jed Apr01,2015 03:36PM Trans-it
20 $850.00 MCRCLERK - MCP,-City Clerk
4:1 MCR#: 402800
ITEM(S): TOTAL: $850.00
Check (00005900) PAID $850.00
Have a nice day!
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