Mark Cannon/Chabad Lubavitch
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lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the pa~ge/-'Weat ,.,.
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommerMStion:t'ltthe ",
City Mahager or any city board or committee; or any action, decision or recommendation of any city personnel dfRIed lt1.any rn
manner in this section, during the time period of the entire decision-making process on such action, decision or reco.p)nendatlon a
that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specificallY;:iE!dudW'the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. ipl4asefhlrer
to Ordinance 2004-3435,
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Cannon
NAME OF LOBBYIST:
Mark
Miami
(City)
FI
(State)
(M.!)
33156
(Zip Code)
9400 S. Dadeland Blvd
BUSINESS NAME AND ADDRESS
(Last)
PH 1
(Number and Street)
(First)
(305) 670-0001 x212
TELEPHONE NUMBER:
FAX NUMBER:
EMAlL:
I. LOBBYIST RETAINED BY:
Chabad Lubavitch of Venetian Causeway and Surrounding Islands, Inc.
NAME OF PRINOPAl/CUENT:
115 7th Terrace, Miami Beach, FI33139
BUSINESS NAME AND ADDRESS (Number and Street)
(City)
(State)
(Zip Code)
305-674-8400
TELEPHONE NUMBER:
305-535-5260
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (e)]
. 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:
~,14J.nv-, "D',nu~ J~,O~ O-i. ~ VQ/u-J~ n..s.~
I..ueto be I~~ (Desc~;:d~ D .. H-::;> ~
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Board
Planning Department
.
e
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ tDIlD
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). . Vn" L~ 0
:0: .::::~ reDresentina a not-for-Drofit corDoration or entity without soecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Artide VII. Division 5
Thereof Entitled "Cameaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Procurement Issues":
y,
Are ou lob i n nt or i i for oods
or endina award for GOods. eauiDment or service?
m or servi
r na
2)
Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII DMslon 5
thereof Entitled "Camealon Finance Reform". Via The Addition Of Code Section 2-490 Entltled "Prohibited
Camoale" Contributions BY Lobbvists On Real Estate Develooment Issues":
Y
lobb in n in a Ii n r a Dev I A reem w' h h C'
aDDlication for chanae of zoninG maD desianation or chanGe to the City's Future Land Use MaD?
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 COMPENSATlON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATlON DURING THE
REPORTlNG PERIOD. , C. ~ ~ ~~.~
Slgn:te~u~
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 e Miami Beach City Code and all reporting
requirements.
Signature of Lobbyls .
Signature of Principal/Client: ~
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced 10
Form of Identification
~rsonally known (Principal)
Form of Identification
~rsonally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
5ignature of Public Notary - State of Aorida
Notarization of Principal's signature
___ PIIdll
~~ MyCan.,i..........
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nature of Public Notary - State of Florida
Notarization of Lobbyist's si9nature
FOR
Annual Registration fee: [ ] Yes [ ] No Amou t
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F:
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MARIA-M\LOBBYISl\LOBBYIST FORM 04