Linda Polansky/Espanola Way
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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 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 ULobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
POL.ANSk:i LINDA.
NAME OF LOBBYIST: (Last) (First)
~P.4NoLA lA.JAt eoR p. , ('f 3 ~ ~~I..I~~Vl AUL/A.l.lJj
BUSINESS NAME AND ADDRESS (Number and Street) (City)
?>~,>-(P13 - (!)II~ 3oc;~ ('13.11~
TELEPHONE NUMBER: FAX NUMBER:
11. l'''~:
(State)
(M.!)
&A..&. (H- ~ '31~;
(Zip Code)
EMAIL:
I. LOBBYIST RETAINED BY:
is'') PA('JOLk
NAME OF PRINCIPAL/CllENT:
wAi coR p.
I c.f 3 &-' Wtt.-s ~ i f\4 /, Y) Ave I ftt.lt~ I
BUSINESS NAME AND ADDRESS (f'lumber and Street) / (City)
305"- ~73-01l')....
TELEPHONE NUMBER: FAX NUMBER: (Optional)
Bt4c.fI.{ FL-
(State)
"33/31
(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: LI N bA PO L ItN$!<y
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION. PARTNERSHIP OR TRUST: ti]) w.tfr. t>. 5"bl.. 12 E:(2.. r (2 tlf 0 c.tBLef -r,eu s r
fib ~H(LJ4t-Tt.. - 6.4 U6 er
II. SPECIFIC LOBBY ISSUE:
-;ZOYlln
va. n (( I1L(,,5
re. tfl.f <6 Gs 4no/e... WOo.
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Issue to be lobbied Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
flDnf(tJ'(sfMf!oA) (
'~
. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
NoN€
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~(E IV 0 AI E
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv 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 LobbYists On Procurement Issues":
Yes (;)
Are you 10bbvinG 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 Otv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian 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, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P EDING CA ENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP URES PENSAT N DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions co ined in Sectio -482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
fo S"&.t!1ol1
VI. LOBBYIST IDENTIFICATION:
~ucedID1f1C\.. 'D(2CLlM ku<<.--,
Form of Identification
PRINCIPAL I NTIFIcATION:
~cedID el, b(2(~u G~/'A/;J'
Form of Identification
D Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
D Personally known (Principal)
State of Florida, County of Miami-Dade
SWom '0 '1'" ~"""EZ ^ ,j
"0.' < . ,day of .20!0
~ tL~;; \
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
~ tI\. Christina Collins
. ~; My Commls8ion DOO~9838
'\):..,..d"" ExpireS September 23, 2005
State of Florida, County of Miami-Dade
SWo~~, re me cI
This 1\ da of _ ' fJ2....fl1
~
Signature of Public Notary - State of Florida
Notarization of Principal's signature
",. ".!It. Christina Collins
!~"'f; My CommiIIion DOO~9838
'\):..~ ExpIres SepIember 23,2005
)F ~31
FOR CLE
Annual Registration fee: P<;I Yes [ ] No Amount ~d
Lobbyist Registration Form received and verified by: L'
Revised 02/10/04 F: CLER LL\M
Date Paid ~
BYIS1\LOBBYIST FORM 04