Howard Gross
~
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk.@d.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
-
RECE\VED
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2~ ~tt j 'J ~1'110; t.?, ,
1:1 Check Box if an Amendment CITY CLERK'S OFf ICE
GROSS
NAME OF LOBBYIST:
HOWARD
(Last)
(First)
(M.I) DATE QUAliFIED AS LOBBYIST
407 LINmToN ROAD. PENTHOUSE S.E. MIAMI BEACH. FIDRIDA 33139
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
(305) 534-4757
TELEPHONE NUMBER:
(305) 538-5504
FAX NUMBER:
1349 DADE BLVD.
BUSINESS ADDRESS:
MIAMI, FIDRIDA 33139
(Number and Street) (City)
(305) 534-6328
FAX NUMBER: (Optional)
(State)
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EMAIL: (Optional)
I, LOBBYIST RETAINED BY:
'RRll~ 'lY"1ATTN~ TNt""' IMA"RK FFRTlt.
NAME OF PRINaPAl/CUENT:
(305) 534-2128
TELEPHONE NUMBER:
Fill out this section If prlndpalls a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFACER, PARTNER, OR BENEAaARY:
. UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECT1. Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
'roWING FEES and REGULATIONS
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
.
ALL AGENCIES
.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: $17<; 00 ;In nOllr
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
$17<; 00 ;m nour
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
Are YOU lobbyinG on a aresent or aendinG bid for Goods. eGuiament or services. or on a aresent
or oendina award for aoods. eGuiament or service? 0 Yes -iJIIo
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
Are YOU lobbyinG on a aendinG aaallcation for a DeveloDment AGreement with the City or
aaallcation for chanGe of zoninG maa desiGnation or chanGe to the City's Future Land Use MaD?
OYes1frNo
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY 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 for
familiar with the provisions contain
reporting requirements.
Signature of Lobbyist:.
Signature of Principal
VI. LOBBYIST IDENTIFICATION:
CI Produced ID
o Personally Known
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This :s day of rl(u, '- . 200~
Florida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: .P\fACCEPTED
If rejected, state reason:
Registration fee paid:?1~ ] Cash l><fCheck MCR #
DATA ENTRY DATE: ~ ENTERED BY:
2nd Revision 3/18/03
[ ] REJECTED
DATE:
(-6-01.{-