Terry L. Jastrow / Jastrow Prod
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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 spedfic exclusions. Please refer
to Ordinance 2004-3435.
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TELEPHONE NUMBER:
(City)
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FAX NUMBER:
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LOBBYIST RETAINED Bn ...
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
(City)
Los.. ~ ( -eS /(!+- 't 00 C.{<f
(Slate) (Zip Code)
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EMAIL: (Optional) .
-Sco 25002CS
TELEPHONE NUMBER:
'5( D .r? 300 CD'!
FAX NUMBER: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: / J
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR T.RU5T: .t1. J
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SPECIFIC LOBBY I,pE:
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Issue to be lobbied (Describe in detail):
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In. CITY AGENCIES/INDMDUALS 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,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) '/-.( r'J'(-t.a.. - ~fl-~~ i 105 (~ dJ tJ..eC.Of"-'IU,:tf-
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CO~PENSATION): (Required). N.b K-EC - ~O~M~ h{~.J ~V R..C{j{J~
1) Pursuant to Ordinance No. 2003-3393 AmendinG Miami Beach City Code Chaoter 2, Article VII. Division 5
Thereof Entitled "Camoaion 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 AmendinG Miami Beach Oty Code Chaoter 2, Article VII Division 5
thereof Entitled "Campaign Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
CampaiGn Contributions Bv Lobbvists On Real Estate Develooment Issues":
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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. ~ I
Signature of Lobbyist: (~~ ~O e-
Signature of Principal/Client: ..J~'($-OCJ-;J .p~~ C>~ o;..s.
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced I~/ IJr tic. #9/~
Form of Identification Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miaml- de
Sworn and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
PAULA CALDeRON
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-M\LOBBYIST\LOBBYIST FORM 04
FOR CLE
Annual Registration fee: [~. ] No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: ClER\AL