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Mango's Tropical Cafe ,.1iomi 9e;;xh .... 'Qll! .1(JU:3 ~ ~ ~ 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 "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435. rre~ ~~~ (Last) (First) 1. S is (Number and Street) (City) 7<l' ).S- NAME OF LOBBYIST: GtCAV\S BUSINESS NAME AND ADDRESS 30$ 376 'f ef..~ TELEPHONE NUMBER: I. LOBBYIST RETAINED BY: ~~OlENT~1 We- '(. (Number and Street) 4l/jJ.. 331 (Zip Code) BUS ESS NAME AND ADDRESS ~()~'-h7~ 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 INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: ~~es ..Jo Ni~~ Issue to be lobbi (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: ~. ^t:NA.U- A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship ~~ ~VV\~ssj~ .rM'1r P\t)~~; l>~ Nei llo~12 5y'^~.s V\ tn'\ e. ~~ )'\.1 ~ e.. ISE ON;~R # 1 77 9~O '">ate Paid FOR CLE Annual Registration fee: [ "'1'Yes [ ] No Amount Par Lobbyist Registration Form received and verified by: F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 of Pul}f'ic Notary - State of Florida Notarization of Principal's signature SiJhature of Public Notary - Statl Notarization of Lobbyist's signature "''3::/';.'''' l~l:""~~ =*: ~'k: ~... ..~~i "'?= .....~' State of Florida, County of Miami ft_:Jl1f..f:\' d subscribed before me day of 5.P~Wlh.t (. 20 PAULA MAJOROsn-:. MY COMMISSION # DO ~1~~ EXPIRES: November 8, 2008 nded Thru Notary Public UndelWrRers State of Florida, County of Miami-Dade Sworn to and subscribeq before, This A-I ~ day of ~eokM PAULA MAJOROS MY COMMISSION # DD 310341 EXPIRES: November 8, 2008 BoIlded Thru Notary Public Underwriters SIGNATURE AND STAMP OF NOTARY: VII. o Personally known (Principal) , Personally known (Lobbyist) I(Produced ID fL vI"..i.fLO-/'75 ,"'-1 R - W/-O Form of Identification Form of Identification o Produced ID 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. v. SIGNATURE UNDER OATH: 3) Pursuant to Miami Beach Oty 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.. oYes 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": The following infonpation must be answered: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYI~ COMPENSATION (DISCLOSE WHETHER HOlJRLY, FLA TRA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ( *tgO ^,...,.,.... 'IF'