Alexander Tachmes/Espanola Wy 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 "Lobbyists" has specific exclusions, Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First)
BUS]NESS NAME AND ADDRESS (Number and Street)
TELEPHONE NUMBER: F~ NUMBER:
(M.I)
(State) (Zip Code)
EMAIL:
LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street)
(City) (State) (Zip Code)
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: L/~b/~ pof..~AJ.~/~)/i/¢7~~-j~/~rA/~-
O
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5 Yo OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
~' v~,',,,,,,~,.,.- £.c
Issue toJ~e lobbied (Describe in detail):
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
~n/-ry ~b,~/~,.rrfZ,%T,o~, c Fry ~
B) Any Financial, Familial or Professional Relationship
Yes
Yes
DZSCLOSURE OF TEEMS AND AMOUNTS OF LOBBY[ST COMPENSAT1~ON (DISCLOSE WHETHER HOURL ¥,
· FLAT RATE OR OTHER):
A) LOBBY[ST DZSCLOSURE: (Required) ~'
B)_.~P~NC[PAL'S DTSCLOSURE (OF LOBBY[ST COMPENSAT[ON): (Required).
N('~o: } Are you representinq a not-for-profit corporation or entity without special compensation or
'l%qm~ursement. Pursuant to Ordinance No. 2004-3435.
No:
2)
Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chapter 2, Article VII, Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
CamDaian Contributions Bv Lobbyists On Procurement Issues":
Are you Iobbyinq on a present or oendino bid for qoods, equipment or servia;, or on a present
or oendine award for aoods, eauioment or service?
Pursuant to Ordinance No. 2003-3395 Amendinq Miami Beach City Code Chapter 2, Article VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Real Estate DeveloPment Issues":
Are vou Iobbvinq on a pendinq application for a Develooment Aareement with the City or
application for chanqe of zoninq map desiqnation or chanqe to the City's Future Land Use Map9
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYZST SHALL SUBMZT TO THE CTFY CLERK A SZGNED
STATEMENT UNDER OATH, LZSTZNG LOBBYZNG EXPENDZTURES, AS WELL AS COMPENSATZON
RECEZVED, ZN THE cTrY OF MZAM! BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEMENT
SHALL BE FZLED EVEN ZF THERE HAVE BEEN NO EXPENDTrURES OR COMPENSATZON DURING THE
REPORTZNG PERZOD. ~ ;i~~
S gnature of Lobbyist
! do solemnly swear that all of the foregoing facts are true and correct and that T have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
Signature of Lobbyist:
Sig nature of PrJncipal/Client:"~/
v~. LOBBYTST ZDENT[FZCA'rZoN: [CAT[ON:
E~ Produced ID ro~du~d iD ~-(~
Form of Identification Form of Identification
~Per~nally known (Lobbyist) [] Personally known (Principal)
VZZ. SZGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn .to and subscribed before me
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Swo r r)~/a_ ,nd-s,u bsc ri bed',be fqr~e me .,
This J'~ ~-d&y of/~. 200 5'
Signature of Public Notary - State of Florida
Notarization of Principal's signature
. ~,,~. Chr~flna C~ns
'~1~i? ~ ~ 23, 2~5
/
FOR CLERK'S USE ONLY ~.~ ~ / ,,
Annual Registration fee: [ ]Yes~-/JNo AmountPaid ~Z,_~"~Ot") IV~.R# I~(~ DatePaid
Lobbyist Registration Form receiv, ed an'~ vedfied by: L~'2i~ ~ 1 .~/~/ , .4 ~