Villas del Mar
lD
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emall: cityderk@ci.miaml-beach.f1.us
LOBBYIST REGISTRATION FORM
-
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
""""'Check Box if an Amendment
NAME OF LOBBYIST:
Bass
(Last)
3.
4(p
BUSINESS ADDRESS:
,~~ 3'01 -WAO
LEPH NUMBER:
Te-PPn
(First)
S.W. I Sf Stree-t M/am'"
(Number and Street) (City)
(3C6IAX~~~;R?45 7
nor -fbr~
LOBBYIST
F/of/da -33/30
(State) (Zip Code)
ihassfshub,nlxlss .CtJtn
vEIL:
(M.!) DATE
I. LOBBYIST RETAINED BY:
JiI las ])e J Mar
NAME OF PRINCIPAl/CUENT:
and
see a#arJJed
BUSINESS ADDRESS:
(Number and Street)
(City)
(State)
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a .CorPoratlon. Partnership or Trust [Section 2-482 (c))
. NAME OF OiIEF OFFICER, PARTNER, OR BENEFICIARY:
. UST AlL PERSONS HOLDING, DIRECT1. Y OR INDIRECT1. Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR lRUST:
II. SPEOFIC LOBBY ISSUE:
..'.,
Issue to be lobbied (Describe In detail):
m. an' AGENOES/INDMDUALS TO BE LOBBIED:
A} Full Name of Indivldual/Tdfe
B) Relationship
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
-t-l."\f .it :) 1~
prr
l..,-
A) LOBBYIST DISCLOSURE:
B) PRlNCIPAL"S DISCLOSURE (OF LOBBYIST COMPENSATION):
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform~ Via The Addition Of Code Section 2-"188 Entitled "Prohibited
CamDaion Contributions By Lobbyists On Procurement Issues~:
Are YOU lobbyinG on a Dresent or oendina bid for Goods. eauiDment or services. or on a Dresent
or DendinG award fDr Goods. eGuiDment or service? 0 Yes 0 No
. .'
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
t~ereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv lobbvists On Real Estate Delielooment Issues~:
Are YOU lobbyinG on a oendinG aDDIi~tiDn for a DeyeloDment AGreement wit" the City or
IDalkation for chanGe of zonind maD desiGnation or chanoe to the City's future land Use Mao?
DYes D No
V. SIGNATURE UNDER OATH:
'. " . " ,\' ", ,., - ;...
ON OCTOBER 151' OF EACH YE.R, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing ~
familiar with the provisions contained in
reporting requiremen
e true and correct and that I have read or am
2 of the Miami Beach City Code as amended, and all
VI. LOBBYIST IDENTIFICATION:
FonnofIdentification
~erSOnallY Known
o Produced ID
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before m
This ~ Mi'Yof Ou-e......t...t()O 003.
\l II OF
0"''' Ol~ EUZABETH LKELlV
~ ~ ~ COMMISSION NUMSER
~ 0( 00036311
71- 0# MY COMMISSION EXPIRES
OFF\: JUL V 13,2005
te of Florida
6lA "t~ -E-"T 1+ Ie c;;t-.... Y
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
RegIstration: [] ACCEPTI:D
] REJECTED
DATE:
If rejected, state reason:
Registration tee paid: [ ] Yes [ ] No
DATA ENTRY DATE:
[ ] Cash [ J Check MeR.
.2003
ENTERED BY:
2nd Revision 3/18/03
F:\CU:R\HA n \Lobbyists\registrationa03.doc
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@ci.mlami-beach.ft.us a
LOBBYIST REGISTRATION FORW
-
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2.481)
~
(M.I) DATE QUAUFIED AS LOBBYIST
11(-". FI""J] / 1:1.
(State) I (Zip Code)
~C/J. - ~ . r..,
I. ~~ST RETAINED BY:
~~/t-
NAME PRINCIPAI./CU NT:
7 ).00 ~ ~ 15' d ~h--4' ./lc0i ~"c
BUSINESS AD~ESS: (Number amfStreet) (City) { (State)
flv/A
TELEPHONE NUMBER:
(q"rt"'tA ::"/"1 4~("
..-.-
I "\(
)/ R 3J.(_
, (Zip Code)
---
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust (Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. UST ALL PERSONS HOLDING, DIREcn. Y OR INDIREcn. Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
U. SPEaRC LOBBY ISSUE:
---r;.f Ii ~ / T?- L. ? F ! u /{ Jvu.. d /"Vt T
Issue to be lobbied (Describe in detail):
UI. art AGENaES/INDMDUALS TO BE LOBBIE~
A) Full Name of Indlvidual/T1tle B) Relationship
C-o 1V1(.s~(cJ;""
f L (" \
J
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHER~
("............
A) LOBBYIST DISCLOSURE:
B) PRlNCIPAL"S DISCLOSURE (OF LOBBYIST COMPENSATI N):
1)
Pursuant to Ordinance No. 200]-]393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-"188 Entitled "Prohibit~d
Camoaian Contributions Bv Lobbvists On Procurement IssuesM:
:~:~:i~~b:~:~d 0:0: :==:.n~:~i:e':e~~:rb~:~~:og~e~a~ent or services. or on a Dresent
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions 6v Lobbvists On Real Estate Develooment Issues":
. Are YOU IObbYina on a Dendina aDDlication for a DeveloDment AClreement with ~e City or
~~t;:on for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OTY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing are
familiar with the provisions contained in Ion 2-
reporting requirem
Signature of Lobb .
Signature of Principal/Client:
VI. L088YISTIDENTlFICAnoN: mr--::S:~+fr~ 'bM.S
IJ!'" Produced 10 FPL.... B2.Q) ~ '3 J - (.,1- I 07- 0 0 Personally Known
Form of Identification
d correct and that I have read or am
e Miami Beach City Code as amended. and all
VII. SIGNATURE AND STAMP Of NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This C\+t, day On;eC-rl.Iher-. 2003.
ICIAL NOTARY SEAL
LILLIAN BEAUCHAMP
NOTARY PUBUC Sf ATE OF FLORIDA
COMMISSION NO. 00109289
MY COMMISSION EXP. APR. 29.2006
fOR CLERK'S USE ONLY
Registration: iXf ACCEPTED
If rejected, state reason:
Registration tee paid: ~es [ ) No
OATA ENTRY DATE:
[ 1 REJECTED
DATE:
.-1'2., q,- 03
~s-1S-(J
[lCash ~ MeR.
. 2003 ENTERED BY:
2nd Revision 3/1B/03
F: \ClER\HA n \l.obbyists\registrationa03.doc
, .
18/29/2884 88:54 3855341588
Vr;O-]u-2003 WED 10:55 An SHUBIN & BASS
JBI
PAGE 81
FAX NO. 3053819457
p, 02
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VD. 1aINA'IUU'" Sf AMP OF..orAllY OIl DIM1' a.IIUCI
State or FJorIda, County of Miami-Dade
~~. D!;~~~~D3.
0' o>~ EUZABErHLKELLY I
~ r~ ~ COMMISSION NUMB"", .
."'.-'71< T. i- MYCO~M~~~~hrlC1,,::.1
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011 0I:I'0II..11IIf 01' IACIt YIM. Be" Lolllnsr SIUU.SUIMIr 1'0 THe cnT CLERIC A SIGNED
SfA1!M1!NT UNIt ='1, OIlTH, USTING LOII'rlNG !XPII!NDrTURIS IN THI art OF JlUAMllEActt fOR
THI PRECEDING ':'IUNDAR YEAR.
and CDrnrct and thle I haw re.d or lII1I
af the Miami Beach CIty Code iIS ~ended, and all
VI.
CI Prcd~ J :)
Form 01' IclentlRCiltion
t Pe'sDnllDy ICnawn
VII. SlGNA1U'lIt ,1"'0 S1'AMIl OF IIlOfdT 01' DEPU1"Y CUIUCI
~
Signature or Ie Notary - State 01' florida
~ U:1..))-8(?7C-!.- k: p U'" v
Print, stamp or type name of Notary Public I
Fe'" Q.IJlK'l UK GNl.1'
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Dee 10 03 10: a ...
DEC-IO-2003 WED 10:26 An SHUBIN & BASS
(305) 604-0543
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FAX NO. 3053819457
P. 02
tv, DI5ClOSUlu: Ol' TaRMS AND AMOuNTS OF LOUIYIST C';aMPENSATION (DlSCLQSI \ll'lfnHEIl HOURI. r:
1'lATICA1FOIf07Hnf~ ,
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~ EfttittM ~r~""'a: l~;-O;: ~~ ~':ra~" .::;"itiGn or Cod. ~;,.,. 2-'!J. Ern.itJed RProhibited
Otmnamn Cftntrih...v.n~ j.'ODmlIInt ICCI.~
an. -. JDI&bvi_..... -din. .1NIIira~ ~1'fI!I-- _--_at 11.:ttI tl&e Citv Dr
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CY'_ n Nq
v. SIGIIlA'RIIIE UNGER 0&TJt:
GIll oaoua IS!' OF UCIt VU....IACH l.OUYJsr SHALl. SIiI.MrTTD THE CITY CLIW:I<. SlGNID
STA1DIIJn' UNDEIl o.TH, USItItG L088YJN& fXPENDrrulWi IN THE CITY Of "11 "'MIBUOt FOR
THE ""ECEDING QLeI'tDAll YEAR.
I do SOlemnly swear that: ." Of the I'Dregolng
famiJiar Mth the " 5 cantained In
tepOI'ting reqw
Signature rI
Signature of
g Praduced 10
II nd correct and that I hiJ v ~ read or am
Oftt!ll Miami Beach City CodI!;1$ amended, and all
VI.
~aIIVi(I'lown
VII. _NAlUIIE MID sr",,, OF NOTARY all DDVrT CUIUC:
State of Aorida, County of Miami-Dade
~~~";:~~200J'
I :\~V(l ""{I I"- 'CIALf\JuIY~U'J_ ...N
o -l'c::- EUZAaETHLKELLY I
~) 0 i
,. COMMISSION NUMBER
~ ~ 00036311 ,
'} 0 o~ MY COMMISSION EXPIRE.S .!
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lllegllL6..1ee pIid: [ J Yes ( ] No
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FAX NO.
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FAX NO. 3053819457
P. 02/02
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