Jeffrey Bass/Browns Holding LLC
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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.
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NAME OF LOBBYIST: (La~t) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
( 3 oS) :r)?\'" <oe60 ( '0.$) J'f\.... q'{ S"l ~ 1.0", s.1 ~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
~
(M.!)
f'1\ Il- MI. F'L.. 3313 0
(Zip Code)
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I. LOBBYIST RETAINED BY:
~re.\.,.)~ Ijo\J\y-..~ILLC I Me. N-Qlso- Fox
NAME OF PRINCIPAL/CLIENT: I
\C,~s ().J<Ash\Y'.&~ 11 \~Yh'
BUSINESS NAME AND ADDRESS (Number and Street)
(SoS'J 715 t1y 55
TELEPHONE NUMBER:
&~CL
(City)
FL :33\3<l'
(State) (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 BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
fT" ~.(." ...... ~ S.s
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER).
-t A) LOBBYIST DISCLOSURE: (Required) ... t.tSo' 00 l. or \... J
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ '1'$0 .00 h -or l'(
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 1(NO: Are YOU lobbyina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes "No: Are YOU lobbyina on a oendina aoolication for a Deyelooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
Mao?
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 ~ No: Are YOU reoresentina a not-for-orofit corooration or entity without soecial comoensation
· or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, A
RECEIVED, IN THE CITY OF MIAMI BEACH FOR TH E ING E ~
SHALL BE FILED EVEN IF THERE HAVE BEEN NO PENDIT R 0 Oi
REPORTING PERIOD.
----<
familiar with the provisions
req u i rements.
Signature of Lobbyist:
Signature of Principal/Client:
~""\\\~'EU!V4fJ"'l LOBBYIST IDENTIFICATION:
~ ~\,." L[y ~
~~~\, ....... ~~
~ ~'V ...~Q~ EXP/~...D ,1"'''SI!!duced ID
~!;f"'~C:JC:> ~ 2009 ~cS' .... ~ Form of Identification
~::j:~.:.." ~A:.~
-LLi. <:> ~ ~.Q~
i : ~ ~.~ ~nally known (Lobbyist)
:.'::E , ~ ID.O::
~ ~.... \~~ v~~ll ii:.~'ATURE AND STAMP OF NOTARY:
~ T · Bo"'~ .. ~~..
~ .. M ~\I:,v..~ ~
~4'oi;..~~~~ft!~~~rida, County of Miami-Dade
~11111,11'1 PUB~~t) aed subscribed pefore me
",,,.."~'r~/o"i day of O~Iu~ , 20.0.
PRINCIPAL IDENTIFICATION:
/' J). / 0 . C-r;ltJ {J.{ ;;tJ - s. V-Jf! & V
~roduced 10 ~L-~I~~ /-
f Form of Identification
o Personally known (Principal)
. ~ FORLE
Annual Registration fee: [ ~s [ ] No Am un P id
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.t1oc
:r ~ "" ~ \aw'j"""" \ ".~ A l.Co~~'l ('$.4.. .p t oS' c r oS"
State of Florida, County of Miami-Dade
Sworn and subscribep b fo e me ,_
f 20 Dj
Date Paid to It 0 /0(("
I I
Revised 12/08/04