William Talbert/GMCVB
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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, dedsion, 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 ~LobbyistsW has specific exclusions. Please refer
to Ordinance 2004-3435.
BUSINESS NAME AND ADDRESS
Jb5 s'31 ]oyo
TELEPHONE NUMBER:
~ 7(JLBJ;.(LT
NAME OF LOBBYIST: (Last)
70t ~ ~ -:/1-2..76"
(Number and Street) (Oty)
36<1 S37 3/-z-6
FAX NUMBER:
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Y.
(First)
NlA
(M.!)
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(State) (Zip Code)
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EMAIL:
I. LOBBYIST RETAI~ED BY: . ~ '
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NAME OF PRINOPAl./CUENT:
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BUSINESS NAME AND ADDRESS
:3o~--r]7 )OYD
TELEPHONE NUMBER:
fti.A
f) e:J3/31
(State) (Zip Code)
~~ '7--' vJ-. e",...
EMAIL: (Optional)
(Number and Street) (City)
3"J r3731").-}
FAX NUMBER: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c}l
. 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:
.
~
'.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TQ..BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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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 Lobbvists On Procurement Issues":
o Y~)pJ No:
Are YOU lobbvina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoalan 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 E ENDITURES OR COMPENSATION 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 contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. I, ~ A .
Signature of Lobtiyist: l/v' ~ t/~
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
. nature of Public Notary - State of Florida
otarization of Principal's signature
l-J Produced ID
lJ Produced ID
Form of Identification
.; Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
c Notary - State of Florida
f Lobbyist's signature
I':~ Toni Johnalon
. ~j My CommIuIon 00118251
~...~ Explres~08.200l1
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04