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Green Comet LLC .... ~ r.1i;m'11i Bc:ot:h - - 1.uO ~ 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. Gvm Il-lt-L A-It1L-edu NAME OF LOBBYIST: \ (Last) (First) J L-C \ ~~'\c. h-e.\ I Alfenue.. M-- i3 · \;:L BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) W~ rs/~-0588 ~O '1(0/...5588 T TELEPHONE NUMBER: FAX NUMBER: (M.!) 331M (Zip Code) Go nz- p..~"Z.-A:J €-3-ILA w .&JJt.l EMAIL: I. LOBBYIST RETAINED BY: ~ft1 c'J)jMP--t L. L.C. NAME OF PRINCIPAL/CLIENT: ~ln '. AI 'e<S~/"'1\cllUi f f>1lf\-r-f.f, " llCf Wk5hl~sfw A-ue. BUSINESS NAME AND ADDRESS 305 to 72...'5IS L... TELEPHONE NUMBER: jL1il/Ytrl ~~trd1 (Number and Street) (City) {:" I (State) 33(39 (Zip Code) 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 BENEFIGARY: AJt'~'SAltd120 {Q.Tl~fJ; IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: q~ ~S ~~C)V~ II. SPECIFIC LOBBY ISSUE: Cc-L ~. Dt ~~"l rt-OtL,,~. \"'&,\T~ S VA Li ~ ~ r:: J Issue to be lobbied (Describe in detail): OC'r1t-P ell( . III. crrv AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RA TE OR OTHER). ~ d6 J ' k A) LOBBYIST DISCLOSURE: (Required) !2 r ~ ---- /t.uU" :5: B) PRlNOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~tl ~ kIf 5 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 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes 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.. DYes nsation 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 CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU 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 con i in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyi VI. Form of Identification PRINCIPAL IDENTIFICATION: )<-produced ID F L 1) L Form of Identification o Produced ID ft Personally known (Lobbyist) 0 Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: ~, Berh HundMdt \~ · MyCommWu.1DDMa1 State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade o;r:/ Expires Octeber 22. 2OD7 S~orn toand subscribed before me"..,v'-_ Beftha Hundevadt sw.orn and subscribed before me _ ~'S /.3 day of Se"'.'2~~~~S ~ dayofSw-' .200' ~ " ~..-. ~-c-e~i=xp\fesOcteber22.2007 -:(> ~7/""'- #~/~~ I . ature of Public Notary - State of Florida Signature of Public Notary - State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY . kfii Annual Registration fee:,)><'] Yes [ ] No Amount Paid .:2-6 Ct::) MCR # '.2-~ Date Paid SJ 13 Lobbyist Registration Form received and verified by: h~~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.d'be' Revised 12/08/04