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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 "Lobbyists. has specific exclusions. Please refer
to Ordinance 2004-3435.
_l2>o\D\Jro. I Pa +r; cje... J N .
NAME OF LOBBYIST:-/ I (Last) , (First) 1t.jtfII3(f'}ltwl 11-k.."
::Jgm DAk-doM a ~ . LLP. 1Dw ~016w /s--o. Ii /'rf/a m/I k 33/5 I
BUSINESS NAME AND ADDRESS I (Number and Street) (City) . (State) (Zip Code)
(305"") 53b-/ II Z- Cc30S )26 -II/(P PfJ?6 <<iJ~4utJ. Cf'h'l
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
f)et'lrod 6rz:M.10fs'l ~ c. c../o }.// (CIUU.--f f?-e..EY~~i-er
NAME OF PRINCIPAL/CLIENT:
D YlR.. ~ ()(' J1 4/r) On k.d tiU i.lAn I {Jp o.e.h ,6[ 33 /.3 <J
BUSINESS NAME AND ADDRESS (Number and Street) (City) (staf:e) (Zip Code)
('3DD (,po'i- ~.n~ ' (6o:Sj53~- /';;00
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
NAJ~Ck OFFp22.;R;;d BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRU:/i
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II.
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
.FLATRATEOR OTHER):
" / A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
Yes
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division S
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
Yes
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division S
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv LobbYists 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 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~
Si 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 iR--Section 2-482 of the Miami Beach City Code and all reporting
requirements. ~ ,
Signature of Lobbyist: ~
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
Form of Identification
pers~~~!ly known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
State of Florida, County of Miami'Dade
Sworn to and sUbscri~ before lJle ,
This I ~ day of .iOib"I~/2OQ..<(
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Ignatu f Public Nota - State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Swom and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
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Annual Registration fee: ~ ] No Am
Lobbyist Registration Form received and verified b
Revised 02[10[04
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ON GCTOIIII S. Of JM)f YEAII, uat LOIIYIIT' .HALL IUIIGT TO 'nil CITY CLDK A SlUm
IrATlMI!NT _ OATH, usna LOIIYING aPlNDmnIII, AI waL AI car.. _IUlIDN
IIECEIVID, IN 'rHI c:rry aI' MUMI HM:H POR THI! P115ti_ ca....DAR WAIL & sr"TIMI!fn'
SHAU..II FILID IVI!JIIP 1'tIIU HAW _N NO DI'flIIIIHrURD Oil COnrlNMnaN DURING 'l'ME
__._,EIUOP. ~ .
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I do ~ swear ttI8t all Of Ihe fbregCllng tad:s al'll trlJll and lD"l"Ct and that I hive read or am
ftImllllr with IhII prwlllOnl contlllnecl ~Dl'l 2-182 or the Milmi luch CIty Cod. and alll1lpOrtlng
reqUIrements.
SIQnl1ure ~ ~
Slgnatul'lt of PrtndpaVCtlenC:
VI.
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Form rI ZCIIntIk:ItJaV
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JlIMIM 02/UItIM Fl C IMSl\lDIIIM5T FORM 04
10-19-2004 05:22PM
FROM-TEW CARDENAS REBAK
+3055361116
T-l0l P,003/006 F-334
.:V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER. HOURL Y,
. FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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111 koLU\
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Roqulred).
Yes
1) PLlrsuan[ to Ordirtance No. 2003-3393 Amendino Miami Beam City Code Chaoter 2 Artide VII, Division 5
Thereof Entitled "camoaign Finance Reform" Via The At1dirion Of Code Section 2-488 Entitled 'Prohiblted
Campaian Contributions e.v Lohbvists On Procurement Issues":
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami 6eilch City Code ChaDter 2 Article VII Pivi~ion 5
[hereof Entitled "camoaion Finance Reform", Via The Addition Of Code Section 2-4ClO Entitled 'Prohibited
:~:::~::~:i:~t::: :::i:V~:D~~cRa:~::~ ::::::::~::::~ement with the City Or
application for chartae of zonino map desionation or chanCle to the City's Future Land Use M<lp?
Yes
~
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 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 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~. _
~Lobby'lSt
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 containad iF\o.Sectlon 2-482 of the Miami Beach City Code and all reporting
requirements. ~ .
Signature of Lobbyist: ~
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIP"'L IDENTIFICATION:
Praduced ID
Produced rD
Form of Identification
Form of Identification
Per~~ally~nown (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribe before me
thiS I:) day of", I. rL?" 1h->'2Oc..'f
State of Aorida, County of Miami-Dade
Sworn and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Aorida
Notarization of Principal's signature
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Annu~1 Registration fee: ] Yes ( J NO A:O~: ~~:~~N;~ 11 Zz:;i'?{. Date Paid /t;k~:I
Lobbyist Registration Form receive(j and yerlfted by: ' ,
Re'J!sed 02/10/04 F: CLER\ALL\MARlA.M\L08BYI5T\LOBBYIS'T FORM G4