Charles Nabit
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
TELEPHONE NUMBER:
(State) (Zip Code)
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EMAIL:
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I. LOBBYIST RETAINED BY:
CtiA\2\ES NR-8LT
NAME OF PRINOPAl/CUENT:
-=C-L Vallf':GG-lC? GtJDoM'NLUN\ f\SSoc,\I\\LO~ 1"ttJC..
BUSINESS NAME AND ADDRESS (Number and Street) (<;!.ty)'
3c5-b 73-l38( 3~ -535 -6 ~6~
TELEPHONE NUMBER: FAX NUMBER: (Optional)
\&..\'55 OCEf\~ ~\\J S
(~'h 'f\(v\L 8~k\J FL l.3\.J~
(State)
(Zip ~)
EMAIL: (Optional)
Fill out this section If prindpal is a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIaARY:
C.Hp.~\pS ~A~\T- '?ReS\oa~T
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II. SPECIFIC LOBBY ISSUE:
LI'O-G.i:>. \ ~E? ResetSIf\- ,( 0 N C,t-lcell N l to! ~ ~ II N 015 to "l- ~ua.~TtlIlV l'IEN\ .:rS&J ~s l N M. ~ l OEI\C. \.l
Issue to be lobbied (Describe in detail):
III. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/ntle
B) Any Financial, Familial or Professional Relationship
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c.,C, CCMV'J\..lS 51 D N
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IV. DISCLOSURE OF y:.RMS AND AMOUNTS OF LOBBYIST COMPENSAT~-:,;t4 (DISCLOSE WHETHER HOURL)j
FLAT RATE OR OTHER). , cO
~5 ~ ~3/S IL
A) LOBBYIST DISCLOSURE: (Requlred)~ 000. Re1'A,~e: ~ . 11OuR...
'" CO D- (I. ~1S: 00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Requlred).'tf 5 (0). "eTA, ~e..~ /-bJ~
ll~ A n r
reimbursement.
1)
pur:;uant t~~rcli~nC:_NO. 20~~-3~'-3 Amendino Miami Beach City Code !:;haoter 2. Article VII. Division 5
Thereof En i led" m aian Fina e Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
o Yes ~
Are YOU lobbyina on a Dresent or oendina bid for aoods. eauiDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
oYes ~
Are YOU lobbyinG on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aD~Ii~ti~~ f~r chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
v.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E ITUR R COM~ON DURING THE
REPORTING PERIOD. O~
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 con ined in Section 2-482 0 Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
\
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
*ersOnallY known (Principal)
Form of Identification
Ll Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn~ SUbSC~ ~
This ~day of O~'o
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
/" FOR C~t!:S US ONLY
Annual Registration fee: LAYes [ ] No Amo nt:.r)- MCR #
Lobbyist Registration Form received and verified by: "'
Revised 02/10/04' F: \ ARIA-M\LOBBYIS1\LOBBYIST FORM 04