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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 prindpal 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
Oty Manager or any city board or committee; or any action, decision or recommendation of any city personnel 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 dty commission, or a city board or committee. 1l'1e term spedflcaUy Includes tile principal as well as any employee engoged
in lobbying activities. The tenn -Lobbyists- has specific exduslons. Please refer tII Ordinance 2004-3435.
IAc../+Mr::s, ALEM-,v'DER :r:.
~E OF LOBBYIST: (Last) .!fim; (M.I)
A<< ;f.Ar.<.h1l..I:: ~J-..."o;} P.4. ) -< ~..-n.. ~llC."1"'" IS "" I Uc: lC.jO, I1l4 .....i, {:c. s 3' J I
BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) (ZIp Code)
305' -? ?-z1- ICf<</-o 305- 35'D-/Ho c<..,. +c..c..{,.M~S:@4. ,.l:..fJ....,
TELEPHONE NUMBER: FAX NUMBER: EMAlL:
I.
LOBBYIST RETAINED BY,
U<=.-n""v'\; S
A. R~ c... he:..'r&
NAME OF PRlNQPAIJa.IeNT:
2.~2-'"
BUSINESS NAME AND ADDRESS
"5 ()'S-~'74-~b'T5 'if
TELEPHONE NUMBER:
~t1'1 Avtl'l('\'~
(Number and Street)
~1.l~~..:r::C~ I"",J
(Oty)
'lII: .
3 / }of \..""'~ ~...J.I~L T 3/40
(State) (Zip Code)
FAX NUMBER: (Optional)
EMAlL: (OptIonal)
Fill out this section if principal is a Corporation, Partnership or Trust [Section :1-482 (e)l
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DlREcrL Y OR INDIREcrL Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUe:
Lo"f SPlIT (lE .3.500 6AY I! lit: AJIAE
Issue In be lobbied (Describe In detail):
m. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
qso CL......c. ~
./....
1JOi'L~
~-'C'L 17 O~ OO.OC(""'
n111C'AGIIUIIC'I I TGI!wIIIlIIlC'~ r n
oo~a001000
1"'.0
, III. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOROTHER~
A) LOBBYIST DISCLOSURE: (Required)
10 0 l'\ A:....
B) PRINCIPAL'S DISCLOSURE (OF LOB8YIST COMPENSATION): (Required).
rJ 0 VI -e..
The following infonnation must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled ~Prohibited Campaign Contributions By Lobbyists
zment Issues.:
n Yes 0 : A ou 10bbvlnG on a Dresent or DendlnG bid for Goods. eauiament or services. or on a
aresent or aendinG award for GOods. eauiament or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled ~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues.:
nYes ~ Are vou 10bbvlnG on a DendinG aDDlication for a DeveloDment AGreement with the CitY or
aaallcation for chanae of zoninG maD desiGnation or chanGe to the City's Future Land Use
MaD?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
~Iobbyist' as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the derk as required by this
~ but, shall not be required to pay any registration fees..
n Yes ~o: Are vou reDresentlna a not-for-aroflt coraoratlon or entitY without soeclal comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON ocrOBER lsr Of EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, usrING LOBBYING EXPENDmJRES, 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 EXPENDmJRES OR COMPENSATION DURING THE
REPORTING PERIOD. @~Cf/..J).RJW
Signature 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.
Signature of Lobbyist:
Signature of PrincipaVClient: ~
VI. LOBBYIST IDErrrIFICA3
[J Produced 10
o Produced 10
Form of Identification
~PersonallY known (lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
)(.personally known (Prlndpal)
Signature of Public Notary - State of FI
Notarization of Lobbyist's signature
OFRCIAlNOTARY SEAl
ISABel MATUTE LAZARO
COMMISSION NUMBER
00115603
MISSION EXPIRES
MAY 8.2006
FORCLERJ('SjJSE ONLY ",j /
Annual Registration fee: [ ~ [ ] No Amount Paid 2.5,00 MCR # 2-7 t./?f 7 ~ Date Paid ~ 2-1--( t/ 5
Lobbyist Registration Form received and verified by: .i1.M>-'
F:\ClfR\$All\MARIA-M\Lobbyist\LOB8YIST fORM OS.doc Revised 12108/rJ4