New Florida Properties Corp
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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 indudes the
principal as well as any employee engaged in lobbying activities. The term "LobbyistsH has specific exclusions. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST:
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(Last)
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(First)
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TELEPHONE NUMBER:
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FAX NUMBER:
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EMAlL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl./CUENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
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FAX NUMBER: (Optional)
33/~D
(Zip Code)
TELEPHONE NUMBER:
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership Or Trust [Section 2-482 (c))
NAMU~O~~~B~W~~~~ ~(S V~LOAh\ Vp.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWN ERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue t e lobbied (Describe in detail):
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CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
III.
A) Full Name of Individual/Title
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B) Any Financial, Familial or Professional RelatlonshilCj
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER): ~
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired)~:@" .?i~ _
~. Are YOU reDresentinG a not-for-Drofit cOrDoration or entity without s6'ecial comDensation or
. .~mbursement. Pursuant to Ordinance No. 2004-3435.
I)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Rnance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
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Are YOU lobbYinG on a Dresent or DendinG bid for Goods. eauiDment or services. or on a Dresent
or DendinG award for Goods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Development Issues":
V.
SIGNATURE UNDER OATH:
ON OcrOBER 1 Sf 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
REPOImHG .,",OD, ~ .
" nature 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 2-482 of the Miami Beach City Code and all reporting
requirements. l
~~
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
Form of Identification
Personally known (Lobbyist)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
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ignat of Public No ry - State of Florida
Notarization of Lobbyist's signature
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Signature of Public Notary - State of Aorida
Notarization of PrinCipal's signature
FOR CL
Annual Registration fee: [ ] Yes [ ] No Amou ~
Lobbyist Registration Form received and verified by:
Revised 02{1O{04 F:
ONLY ~ i,f1Jlc
MCR #. ~ Date Paid
\MARIA-M\LOBBYIST\LOBBYIST FORM 04
OCT-ZO-04 05:09PM FROM-TEW CARDENAS REBAK
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