Russell Grafton/William Goldsmi
~'j<m"liBrom m
" k'IDd
.........
, 'III'
-
bJU5 -
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
,
!T. N
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passa~ defe~
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendati91};.of ttTIl)
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel define11 'in aAf
manner in this section, during the time period of the entire decision-making process on such action, decision or recomrr9datiqa)
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically incl~s thtt
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Plea~ref~
to Ordinance 2004-3435. r'T1
LOBBYIST REGISTRATION FORM
o
. C>
r
",.
c=
G")
.--J
<.
;0
rn
(')
rn
<:::
rn
CJ
NAME OF LOBBYIST:
GtAFlot\l
(Last)
~SSELL-
(First)
-rH-o ~
~tJ ~~'"
BUSINESS NAME AND ADDRESS
:305' 4~1' 4.QQ3-
TELEPHONE NUMBER:
(City) tot
3o~'~'(I\f)Oz.
FAX NUMBER:
I. LOBBYIST RETAINED BY:
Wll..l..lA"M t\/LWSMITl1 I .]t.h....c.~ eA~s
NAME OF PRINCIPAl/CLIENT:
--.!!fl.b If:NJ j.,S'T 5~t-t:."- I :3(Zi) FLoo~ JUI A-M I, PL '$3-/30
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3'OS..3el. {DOvO ~O.5' 3el. "l4s:t j bt(~s ';)S\tl.t!:i,,~.s..s'(OV\
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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Jl.1\'tJM~6 ~D~ f1 '-'8 $IG,~ SI~LE. PA1AIL~ ~I()1OJT1~
Issue to be lobbied (Describe in detail);
III. cnv AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
PL.Ltt~""INf:\ ~ L.~tJl"-It\
~OtJE:
~l4L. p~ I~
4HPfl
c.rT'I Loto\lllS'!lION J $\ ^, of,
I~ ,
t.Jo
~
.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOUR L Y,
FLAT RATE OR OTHER):
~o
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
Yes~: Are ou re n in a not-for- rafit co oration r enti without s
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Yes """
2)
Yes \lkI!""
v.
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. DMsion S
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoalon Contributions Bv Lobbvlsts On Procurement Issues":
Are yOU lobbvinG on a Dresent or oendina bid for GOods. eauiDment or services. or on a Dresent
or oendina award for Goods. eauioment or service?
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoler 2. Article VII Division S
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions BY Lobbvists On Real Estate Develooment Issues":
Are YOU lobbvina on a Dendina aDDlication far a DeveloDment Aareement with the City or
aDDlication far chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITlJRES, 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 EXPENDIT S COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are true an correct and that I have read or am
familiar with the provisions contained i Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
d Produced ID
Form of Identification
D Produced ID
Form of !<1'll'Yllf@tlo"""C!J\l':""'". c
, 0\1<>(, EUZABETHLKEU..Y
'-VfPersonally known (pri~.:? -1 \: ',J ':'is"'''" NUMBER
'-..,':Y~V ~ DD;):~r-i3j\
~ o~ NY cr)\~MISSiON [;':;:::'--
:~':?!~c-~=-,~.,!UI^Y 1~1_':':':-.
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
. ~ FORCLER,K'SUS.!i..ONLY . ,,11""""""
Annual Registration fee: [~[ ]No Amount ai ili-r\.{) l) MCR~ I~~ Date Paid
Lobbyist Registration FOITll received and verified by:
Revised 02/10/04 F: CLE -M\LOBBYIST\LOBBYIST FORM 04
"8,12 tI)n