Jeff M. Lehman / Tha Palms
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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.
L /9-}"1 ~ J t:PF
NAME OF LOBBYIST: (Last) (First)
T~ f4/,,) 5:..(1. 3o,).~ (01),..)> ,4vc
BUSINESS NAME AND ADDRESS (Number and Street) (City)
3J{ YcJ.3 -9-,}..OI
TELEPHONE NUMBER:
3D S- 7/o1J lcJb~
FAX NUMBER:
"7
(M.I)
i"-J~ /:L 3 ]/~o
(State) (Zip Code)
Jl. 6"?-1??-J,;J tv-9 /70..)'11- .#O/2>l . C 0'7
EMAIL:
I.
LOBBYIST RETAINED BY:
TI+F
P ft t.-;fA. S
s () u TI..f
8 t5-k I..f.-J I nle.. .
NAME OF PRINClPAl/CUENT:
BUSINESS NAME AND ADDRESS
3() --;-- S',lf.-tJ~5
TELEPHONE NUMBER:
~O:2s (Jrl,...., 4vc..J 111~4L{' B.u..c.41 A- 33//(b
(Number and Street) (City) (Slate) (Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-4B2 (c)l
. Jf u.5 Jt::>t..d.;-'1 Ky6........, ~
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: tT7I- ..-
II.
. IDENTIFY ALL PERSONS HOLDING, DIREch.Y OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: f+~,..$ J 0 ~ e.t. ,..... Ie '" L"~ t!
Urs.....llt AL;'I4. 1c-/l.4.-.....{~
SPECIFIC LOBBY ISSUE: ~() I< s1-~ ~ 4>,1 ..../-L-....r' ',,'1 J ~~" "J/,;., ~
cRJUfA_-D//'f"V\ A....J jo<.{J~~ IHkU 4Il ~(/,d.( I-'~(
Issue to be lobbied (Describe in detail): ..j- . or ~ tr~
~ tL. f~f:loW
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
III.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
rJo I'l-<..
tv , yUl..
!bOl<."".J s tt...r<-J +( I'< 1 110..$ f>
n ~,A.L-h.0
IAJrU ~ L ()
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----......- --------
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURL Y,
FLATRATEOR OTHER):
A) LOBBYIST DISClOSURE: (Required) NON 6 J o-r/fGrL rl-lftrJ tJO/ctvtflL utvlfbVSftT/o.J
RINCIPAL'S DISa..OSURE (OF LOBBYIST COMPENSATION): (Required). tJ ONE . ()-rlfffl TH1A1 rJ dilfr/4L
, CAW~NS'ItTI(j1lj
. w .al .
Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Otv Code Chaoter 2. Artide VII. Division 5
Thereof Entitled "Campaian Anance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
Are ::~ 10bb~n: on a ~rese~~ or Dendin: ~~: ~:~. eauiDment or services. or on a oresent
or DendinG award for Goods. eauiDment or service?
yesG)
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach atv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Anance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Yes Q ~~::~:::::SaB::::~:::~:~a::;::::~mentMth HIe atvor
aDDllcation for chanGe of zoninG maD desiGnation or change to the Citv'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, LISTING LOBBYING EXPENDnuRES, AS WELL AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND'\) DR <XlM......noN DDRING THE
REPORnNG PERIOD. ~
SlgrlMure of lobbyist
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 2 of the Miami Beach my Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Prindpal/Client:
VI.
LOBBYIST IDENnFICAnON:
PRINCIPAL IDENTIFICAnON:
o Produced 10
o Produced ID
Foml of Identification
" Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
'Personally known (Prinapa!)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This .9\1" 0 1) 20M-
State of Aorida, County of Miami-Dade
Swom and subscribed re me
This~day of 20~
..~\,'I~'t"'"
"~m<"" ""'6'. JEAN VILLAMIZAR
~. ,~ Notar! eLlb,iiC - State of FlOrida
"';.~ f?'.~y MyComrnss<ooE>;>mMay24.:1OO5
"",OFFJ,\\", 1
Ii otary - State of Aorida
Lobbyist's signature
..,..~~~~~;i'"
!"'m. ~~:. JEA" VILLAMIZAR
~. .~ Nota,')' P~!J~~c ~ Stz:e of Florida
7;~.,. ~~'/ '"!yCa'r",,,,,,n ~'US May24,:1OO5
'1"OF f\;\\~'" _
c _
FORCLE~U~NL ~ ~~
Annual Registration fee: [ es [ ] No Am~(t l) _ MCR Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: ER: \ -M\LOBBYIST\LOBBYIST FORM 04