Michael Travato / Premier
"
~
"
JIM
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.
-n..ov A--r 0
(Last)
~ 1- e:> ffDtJ-r
BUSINESS NAME AND ADDRESS
1C6I-lP:?l1- Q545'
TELEPHONE NUMBER:
NAME OF LOBBYIST:
M I C H A E-L..
(First)
(Number and Street)
'SI. MML~LE-HgtD
(City) (State)
181-(,?;q - q I q \
FAX NUMBER:
MI4
(M.!)
0/1 LfL
(Zip Code)
EMAIL:
I. LOBBYIST RETAINED BY:
fIZt:MfeY<.6 ~ftC,j('..{G- I NC'
NAME OF PRINClPAl./CUENT:
JRfuua,6 ({.flONG- ING' &~'Of\Jr $" Y'VtMZI?>~~f1D Mf1
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
tB\ -<R3q -q5ll-S" 161-(,3Q -q 11/
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
0/14-5'
(Zip Code)
Fill out this section if principal Is a corporation, Partnership or Trust [Section 2-482 (cl]
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEACIARY: fJE,'1""elZ s. C~ 11-1 G- I P R.e5 I D(.NT
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
pE:,~ S' GIZA Ie-
SPECIFIC LOBBY ISSUE: MIA"'" R.FtCe. WeE,\L.... R.E.&.v6ST
\4A1A-M\ ~[U1SI1l)lL*- {oNvtNnoN fuJ1HO~IT~ /l)u",srV1
Issue to be lobbied (Describe in detail):
II.
ft'iNlWlfMeNr
PfZo~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
I\AlftMl &BA-CH Vult tJO
IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
, A) LOBBYIST DISCLOSURE (Required) I NU,V Dt:V IN 6Vi ~\LD~ ee COt/V! (CrJSflll 0 r~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). '{\j62~L. ~ ~. rri'C- If 76 ()
Yes No:
reim
1) Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chaoter 2, Article VII. Division 5
Thereof Entitled "Camoaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaign Contributions By Lobbvists On Procurement Issues":
Yes
2) Pursuant to Ordinance No, 2003-3395 Amendinq Miami Beach City Code Chapter 2, Article VII Division 5
thereof Entitled "Camoaiqn Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaign Contributions By Lobbvists On Real Estate Development Issues":
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 CALEN R YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR C PENSATION DURING THE
REPORTING PERIOD.
nd CO ect and that I have read or am
Miami Beach City Code and all reporting
Q
UJ
>
U") w
'" Si!
eflo Mz!emnly swear that all of the foregoing facts are true
~i1ia:o with the provisions contained in Section 2-482 of
ft.Qui~ents, .
:x::
- "t)....
~ignq1ljre of Lobbyist:
;::.. -,
gilgncfttire of Principal/Client:
,>--
iiI. ~ LOBBYIST I NTIFICATION:
Co ~
PRINCIPAL IDENTIFICATION:
UJ
(.)
U1
a::
'VV
Produced ID
Personally known (Lobbyist)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
i:A!,S!'''-Lhv':>etts t-!o.~t'vsetls 50$(%""'"
State of rroi lea, Count) of t1iemi Dede State sf I'lerida, County of Miit:l>l- ~rlP
~ subscribed before me Sworn an subscribed before me
,This 1: day of Ox:: . 20-'1'( This 20~1.{
SI ~at:r~-:;-~~f ~M~So.{.t"b.!';'(\\s Signature ublic Notary - tate c, Re'rieIlf\.."sd.......w.>
Notarization of Lobbyist's signature Notarization of Principal's signature
/~ ~ ~Q\ "20\0
~~
f':
r- FOR CLERK'S USE ONLY
I Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # __Date Paid
LobbYist Registration Form received and verified by:
I Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
I
r
or
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaign Contributions By Lobbyists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions By Lobbyists On Real Estate Development Issues":
Yes
V. SIGNAlllRE 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 CALEN YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR C PENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are true
familiar with the provisions contained in Section 2-482 of
requirements.
d co and that I have read or am
Miami Beach City Code and all reporting
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST I
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
lA~ s.$<<d1 v SbttS
State of rroflda, CetlAt) of l1illl "i Dtldc
subscribed before me
day of ~ . 20..12 '-l
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
fo1/.1S$/l6bU5t-Ws Signature of Public Notary - State of Florida
Notarization of Principal's signature
,
::;::;;--
~
%
FORCLERK'5US ONLY gL.... ~ W
Annual Registration fee: [ ] Yes [ ] No Amount Paid CR ~ 'J:} --rJate Paid ~
Lobbyist Registration Form received and verified by:
Revised 02{10{04 F: CLER \ -M\LOBBYIST\LOBBYIST FORM 04