Baloyra Patricia M
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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 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.
~fJinJ.~
NAME OF LOBBY T:
(Last)
Jo...Jv l(' A CiI
(First)
jy).
(M.!)
(City) ~....t.Lbt/-YLL
(60$'J~~/o-1 (( [,
FAX NUMBER:
. IS P.
(State) H (Zip Code) ~-3 / '3 i
prv>.h--;:;J ck ill law , (!-lJ /Yl
EMAIL:
lbo s ') s ~ In - (I \ d
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
dS,<) S Wn. 11 -' tlJ..e /1 J.1 L I ( _ C
NAME OF PRINCIPAL/CLIENT: '
qo \. jfJ~o~
() - "C;1P~~ r~
fJ~C!..(.. 'on [' 1-- ~~
(State) (Zip Code)
6rvt 1 ~ ~ (, >- d' <-{)tS).{J. J.rd:i::i JJA.) e.r V\ n I"l ~ oJ
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(60S) t/l \ - lonfn n
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECfL Y OR INDIRECfL Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
...
III.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ ;n 5 '-f.P /\ h...QJ I /I
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes D No: Are YOU 10bbYina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a
Dresent or Dendina award for aoods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes D No: Are YOU 10bbYina on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae 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
"lobbyist" 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 clerk as required by this
section but, shall not be required to pay any registration fees..
D Yes D No: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG 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
REPORTING PERIOD.
~
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 Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
D Produced ID
Form of Identification
Form of Identification
V1J Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
D Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribel;l before me ..----
~~a\.~aYOfNcVdj ,2000
o oMy Mion 1
\;~~ .
Signa e of Public tary - State of Florida
Notarization of L:obbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
./ FORCLERK~USEONLY -//t/Orl c
Annual Registration fee: [ V] Yes [ ] No Amounliffaid 2-,6 cc MCR # /- 7 7 Date Paid t1b
Lobbyist Registration Form received and verified by: L!iUJ/
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
__ _._ ..1- ___ _ __ _ __._. __ _ _" __ __ "._.
IV. DISCLOSURE Of TERMS AND AMOUNTS 0.. LOBIY1ST COMPENUnON (DISCLOSE WHETHER HOIJIUY,
FIAT RATI! OR 07H'R)
A) lOBBYIST DISCLOSURE: (Requkwd) ~ ~15 Lf.l ^
B) PRINCIPAL'S OISCLCisuRf (OF LOBBYIST COMPENSATION): (bqu,....).
The following Infonutlon mu.l be anlWeNd:
1) Pursuant to Miami Beach CIty Code SectIon 2-418 Entitfecl"Prohlblted Campaign Contributions By lobbyists
On Procurement Issues.:
~==~"'.t:;'==="===-"- "0.'
2) Pursuant to Miami Beach Oty Code 2-490 Entitled "Prohibited Campaign Contributions By lobby[sts On Real
Estate Development Issues":
DYes ~ AN VDU lobbvlna on a D8lldlna aDDllaltlon for a DevttIoDmeM Aa.......ent with the CItv or
aDDllad:lon for chana. of zonlna maD dMlanlltJon or chan_ to tIMi City's Ful:unl Land U..
Hul
k!~~;,^ (~
3) Pursuant to Miami Beach Oty Code 2-484 (h) Any person (exC2pt those exempt from the definition d
"lobbyist" as set forth In Section 2-481 above) who only appears as a representative of a not-for.prof\t
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
section but, shall not be required to pay any registration fees..
o Ves [J~O;::::~ a not-for-Drofit col'Dontlon or.ntItv without lIINIdal comD8n_tton
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, !ACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, UmNG 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 EXPENDnuRES OR COMPENSAnON DURING 11fE
REPORnNG PERIOD.
~~
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 Oty Code and all reporting
requirements.
Signature of Lobbyist:
SIgnature of Principal/alent:
CI Produced 10
--.--.."
VI. LOBBYIST IDENTlPlCAnON:
o Produced 10
Form of Identlfk:atlon
<.p:; Personally known (lobbyist)
VII. SIGNATURE AND STAMP OF NOTARV:
Form of Identtflcatlon
~ Personally known (Principal)
state of florIda, County of MIami-Dade
SWorn to and subscrlbe~ before me _ ~
i) 1iI.I:J...-l - ~ iitdayof Neuc4 .20.0->
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~ ~ . o.,IALlA. dll')
Signa Publlc~ - State of florida
Notarization of l:Obbylst's slgnatuN
51 Public Notary
NotBrlutlon of Prlndplll'. .
MTrtpp
My Commission DD178105
.2007
FOR CLERK'S USE ONL V
Annual Registration fee: [ ] Yes [ ] No Amount PlId MeR ,
lobbyist Registrlltlon Form received and verlfted by:
F:\a.ER\$ALL\MARIA-M\L.ObbyIst\LOBBYIST fORM OS.doc:
Date Paid
Revlsed 12/08/04