Castillo, Mayra / Clio Awards
MiamI 1le;Ktt
....'ft~
rqrr
LD
~J
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 pass;J;Ie, defeat
or modlftcatlon d any ordinance, resolution, adfon or decision of any commissioner; any action, decision, recommendation d the
Oty 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 declsJon..maklng process on such action, declslon or recommendatlon
that foreseeably will be heard or reviewed by the dty commission, or a dty board or committee. The tenn specifically In:ludes the
principal as wen as any employee engaged in lobbying activities. The term -lobbyists'" has specific exclusions. Please refer
to Ordinance 2.004-3435.
NAME OF LOBBYIST:
L- 0 A-w~DS
BUSINESS NAME AND ADDRESS
2.12. .<0<6 '3 . 4-0c0
TElEPHONE NUMBER:
~1\~TI LW
(Last)
(M.I)
Oty)
2.) 2...<06 3. 4- -=t- qL
FAX NUMBER:
I
(State) (ZIp Code)
(Y\c.a. sti lb @ci\ o ClLc.XlraS . (('~
EMAIl: I
I. LOBBYIST RETAINED BY:
Quo ~~ps.
NAME OF PRlNCPAL/aJENT:
NL
(State
.2\~.b<i6;3 .~300
TELfPHONE NUMBER:
EMAIL: (OptIonal)
f111 out this section If prindpalls a Corporation, Partnership or Trust (SectIon 2-482 (e)l
· NAME OF CHIEF OFFICER, PARTNER, OR BENEACIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
D. SPECIFIC LOBBY ISSUE:
mi<un'l ~ch \/Crl ; -r6U.~lStV\. A'OJl'iNtuVlfJJ1 ~00f~
Issue to be lobbied (Describe In detail):
m. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
~ttn)\ WttC~ \JC~ Bp~
lV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSADON (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Requlred)c-vvO M~ ~ ~ 01\ - ev~ U: 0 -Awa,c/S
B) PRINOPAL'S DISClOSURE (OF LOBBYIST COMPENSATION): (Requlred).--
Yes (;:) Are YOU reDresentlna a not-for..Droftt coraoratIon or entltv without saedal comDel'lS8t1a1 or
reimbursement.. Pulsuant to Ordinance No. 2004-3435.
1)
..~
Yes (~:/
2)
~/ .\
Yes ~~J
v.
Pursuant to OrdinalKle No. 2003-3393 Amendlna Miami Beach atv Code ChaDl:er 2. ArtIde VII. DIvisIon 5
Thereof Entitled "Campallitn Finance Reform'" Via The Addition Of Code Section 2~ EntItled "Protiblted
CamoaiQn Conbibul:la1s By l.obbyists On Procurement Issues":
Are vou 10bbvlnG on a Dresent or aendlna bid for GOOds. eauiament or services. or on a Dresent
or aendlnG award for aoods. eauiDment or service?
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Ci\V Code Chatter 2. Artide VII Division 5
thereof Entitled "Campaign Finance Reform", Via The Addition Of Code SectIon 2-490 Entitled "Profjbited
Campaign Conbibutions By lobbYIsts On Real Estate DeveIqJment Issues..:
Are you 10bbvlnG on a aendina aDDllcatlon for a Develoament AGreement with the CItY or
aDDlication for chanae of zonina maD desianatlon or chanae to the Otv's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST' SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEAOf FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORnNG PERIOD. /,/ ? 1
; . , ~
I do solemnly swear that all of the foregoing facts are true a d correct and that I have read or am
familiar with the provision contained In . 2-482 of the laml Beach Oty Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Prlndpal/Olent:
VI. LOBBYIST lDENnFICADON:
Produced 10M (/(1. /31 {tf"~~.7
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Signature of Public Notary - State of
Notarization of Prindpal's signature
............n............................
.~p~~ 1
~~ .....,-
~Of.':-...;~ ,:;~
FORCLE~USh?NLY 7.'~j, M
Annual Registration fee: [~ ] No Amo~ ;'57'. dlJ MCR# ~ '8 ~te Paid /1. Y.
lobbyist Registration Form received and verified by: I
RevIsed 02/10/04 F: CLER\ALL\MARIA-M\LOBBYISl\LOBBYIST FORM 04