Jeffrey Smith/Glenna Norton
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R E C 6~Vcf~ami Beach Office of the City Clerk
04 }lM(n():>r~rm~Center Drive, Miami Beach, FL 33139
CIi', CL ERirS cJrq-lt~rST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedsion, recommendation of the
City Manager or any dty board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, 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 ftLobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
~V'I\ IIH ~U~ rrfL\VRA-~ ~(jtJ P 2.0fo "1'hICeS ?lc'ZD. 'Pu.IWlBd1 fl-
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code) 33i-80
Sb/- ~ 32 -31..),-/- '3 P8j}Ilt:.GJr3./C e /MC.COM
FAX NUMBER: EMAIL:
6 ~ \ - $!3.;l.. 020.)-
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
&~tJ1'\ \0 O(ClO\J
NAME OF PRINCIPAl./CUENT:
B~~~~EAND~~E~ ~~nd~ (O~ fA BGH
S30$". q 7).;1..9 is- '305- '8b7. ~;'8C;3
TELEPHONE NUMBER: FAX NUMBER: (Optional)
fl--
(State)
3:SIi-fD
(Zip Code)
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 S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:. . ,
~c;L~~be~d~il):S(V)5le ~I~ re5(at%1Ce Co3Qb No~~~J)
CITYAGENCIES/INDMDUALSTOBELOBBIED: S/Af&,l.-e' F/PTIIL-Y f26flaw7!4t..- f2t1;;~ ~MP
III.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B)
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 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
o Y~.NO:
,
Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGUiDment or services. or on a Dresent
or DendinG award for Goods. eGUiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2, Article VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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 EXPENDITU COMPENSATION DURING THE
REPORTING PERIOD.
of Lobbyist
I do solemnly swear that~1 0 the foregoing facts are true and correct and that I have read or am
familiar with the provisions .." e / Section 2-482 of the Miami Beach City Code and all reporting
requirements. ! ;' /'.;.1
r /i
Signature of Lobbyist: I
Signature of Principal/Client:
I /
VI. LOBBYIST IDENTIFIONTIO
PRINCIPAL IDENTIFICATION:
LX Produced ID ~/. J..,'~
Form of Identification
D Produced ID
J{ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of ~ ^'
Sworn to and subscribed before me "
This I day of . / 20~ .,
....
Form of Identification
~rsonally known (Principal)
State of Florida, County of Miami-Dade
Swor nd subscribed before me , /
Thi$ day of ()t t< ~.a . 2~
Signature of Public Notary - State of Florida
Notari .
COLl.iEN A. HINSON
MY COMMISSION # DO 003287
EXPIRES: March 22, 2006
Boododllvu NoWyN;~ UndI!wrlteI1
FOR CLERI<' USE ONLY /) I L
Annual Registration fee: M'Yes [ ] No Amount Pai \ I MCR # E.., t)1Q(}l'O Date Paid
Lobbyist Registration Forrf(n~~ived and verified by:
Revised 02/10/04 F: CLER\AL MARIA- ~ ST\LOBBYIST FORM 04