Robert Goodman/Art Basel MB
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
BUSINESS NAME AND ADDRESS
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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 tenn "Lobbyists'" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOB0a:1m&/J;} (Lafth-~ (Rrst) s.
sf a/ ~r
umber and Street) (City
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(State) (Zip Code)
(yM/nV/77kr@JC/
EMAIL: . ~ J /J ?In...-,
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I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAljCUENT:
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BUSINESS NAME AND ADDRESS Number and Street) ( ity)
{,?t'~~M-97:q7, (?~'f~~M- 9~7~
TELEPHO UMBER: ~ / FAX N BER: (Optional)
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(State) ~CodeJ
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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, DIRECTLY OR INDIREGL Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS 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).
A) LOBBYISTDISCLOSURE:.(Requlred) /~ &.q~r:;'Ce/Y~<'. r} /P2I7lby ,re/ainor ke kr
Me /Jc7.:5r 4? t/ears 'r a.m~ :rM6 0/ /0;;;[.$.
B) PRlNCIPAL'S DISCLOSURE"(OF LOBBYIST COMPENSATION): (Required). :See '" V,.-, 4.-oq /J~/ JtG.<Zd:""
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 ment or services or on a
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
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBByIST..... ~HALL SUBMIT TO THE c~rrv;, .<;t.ERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL S/ COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR TitlE PRECE ,~l g.,., jJt' E.. A. R. A STATEMENT /'
SHALL BE FILED EVEN IF THERE HAVE BEEN NO J;XPENDI U /6fjlF-; E, SA~ THV
REPORTING PERIOD. i / / f /II I 1/ /
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Signature of Lo~byi
I do solemnly swear that.~. all ~ f, regoing f., '~/ a~ tr ue and correct a~tflat I have read or am
familiar with the prqvisions 0 in~' ~~ <?J,./~mi Beac City Code and all reporting
requirements. L!," /// /1// '/
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Signature of Lobbyi t: / . , I I-
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
r~~roduced 10, h/J'f'F/!:; /;(7~~...
V Form of Identification
~ Personally known (Lobbyist)
WII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
"
" / Produced 10 ~
.
Form of Identification
1N'ersonally known (Principal)
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
~~~R #2-7 /7