John Sadler/BellSouth MIAMIBEACH
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
/n lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First)
BUSiNESS:NAME AND ADDRESS (Number and Street)~i ~,-: :(City) (State) (Zip Code)
~ -~ O~-7&~v -tm '
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS,~NAME AND~,~i,/,/ADDRESS;~ (Number and Street) :~'!'~!~ :F.tY)J ~ : : ::: !': ~ : (State)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(Zip Code)
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:
'issue to be lobbied (Describe in detail):
· II'I. CITY AGENCIES/INDZVZDUALS 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 IfOURZ
Fl.,4 T RATE OR OTtfER.):
A) LOBBY[ST DISCLOSURE: (Required)
B) PFUNC[PAL'S DISCLOSURE (OF LOBBYIST COHPENSAT~ON): (Required).~4,~,~4
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":
·
r ' r i r ' ?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Tssues":
aDDlication for chanae of zonina man desiqnaLion or chanae to the City's Future Land Us'-*~
Ma_n?
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 2-48! 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..
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMTT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, I-ZSTZNG LOBBYING EXPENDTTURES, AS WELL AS COMPENSATION
RECEIVED, TN THE CITY OF MIAM! BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR~ C/Q~IPENSATZON DURING THE
~ ~ §i~'ature of Lobbyist //
I do solemnly swear that all of the foregoing fac~.s are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Clien~//
vi.
LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
L~Produced ID ~ _~>~ ~"'q(oq- ~"-" ~4.~~roduced ID
Form of Identification Form of Identification
Personally known (LObbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of MiamJ-Dade
Sworn to and subscribed before me
This (o-rt~ day of ])P~¢¢MJ~.f', 200~
_
Signature of'Puo,c r~otary-State of Florida
Notarization of Lobbyist's signature
OFTFI~fJ~~3~.AL( ~n~n~Jpal
LILLIAN BEAUCHAMP /
NOTARY PUBLIC STATE OF FLORIDA
COMMISS~{ON NO. DD10028g
M c ~, ,-. ~:.,~
, Y CO~s~l:,~~l~ida?~~Miami_Dade
Sworn and sub~ribed before me
This day of _, 20~
Signature of Public Notary - State of Florida
Notarization of Principal's signature
[~]y FOR CLEANLY
Annual Registration fee: es [ ] No Amount,~Paid MCR #
Lobbyist Registration Form received and verified by:.
F:\CLER\$ALL\MARIA-M\Lobbyist\LO YISTfORM05.'~d~c- ~
.Date Paid ~,,~_~'~
· w
Revised 12/08/04
MIAMIBEACH
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.
NAME OF LOBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) ';~i (City) (State)- (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Z. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City)
'(State)
(Zip Code)
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, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY ISSUE:
!s~s.~ to_be Iobb.!e_d (D_~c_.~ib~. i~_d~t~aj[): ......... '
III. CI'l'~ AGENCIES/INDIVIDUALS TO BE LOBBIED:
rA) Full Name of Individual/Title
/'/4
B) Any Financial, Familial or Professional Relationship
TV. DTSCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (D1'SCLOSE WHETHER I-IOURL
Fl.,4 T RATE OR OTHER.):. .
A) LOBBYIST DISCLOSURE: (Required)
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":
.e~_ es [] No: Are you Iobbvina on a ore~ent or oendin0 bid for qoods, eauioment or servic_es, qr on ~
oresent or oendin_a 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 ,~o: Are you Iobbvina on a Dendinc~ aoo!ication for a Develooment Aqr::ment wi,th the Ci~ Q~
aoolication for chanqe of zonin~ mao de~iqnation or chanae to the City's Future Land Usc
Ma_o?
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 2-48! 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..
[] Yes ~No; Are you reoresentinq a not-for-grofit corporation or entity without soecial ¢omoensatior · '1 or reimbursement.. - '
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMTI' TO THE cTrY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAM! BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDTTURES OR~PENSATZON DUI~NG THE
/.//,/- ~lgnature of Lobbyist:
! do solemnly .swear that all of the foregoing fac, rs are true and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
Signature of Lobbyist: . __
Signature of Principal/Clien .~'/ ' ~
....... oF~l~~~(Frln~ipal)
LILLIAN BEAUCHAMP
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DD~09289
MY ~O~t~:~l~'~'i~a~,?..~o~t~f !M ia mi_ Bade
Personally known (LObbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This [?-t~ day of J~c¢~4i~.f'-, 200~"
nature of'Public Notary - State of Florida
Notarization of Lobbyist's signature
Sworn and subscribed before me
This ~day of ., 20~
Signature of Public Notary - State of Florida
Notarization of Principal's signature
~ FOR CLER~,J,I.~ON LY
Annual Registration fee: es [ ] No Amount'~Daid i~'-"' MCR # ..~.~
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARLA-M\Lobbyist\LO YIST fORM 05.'~c -
Date Paid ~.~.~'~"--
Revised 12/08/04