Harrison-Robbins/ Ocean Dr. PReservation Assoc. City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, H. 33139
~.~BBYIST 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 defined in any
manner in this section, 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 dty 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)
BUSINESS NAME AND ADDRESS
TELEPHONE NUMBER:
(First)
(Number and Street) / (City)
FAX NUMBER:
(M.I)
/4 waB /VFT
EMA[L:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAI./CI lENT: tq'e'T, I I O~
BUSINESS NNVl£ AND ADDRESS (Number and Street} (City)
TELEPHONE NUMBER: F~ NUMBER: (Optional)
(State) (Zip Code)
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 50/0 OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
po - ?(zo c, r Co p,
III. C~ AGENCIES/IND~IDUA~ TO BE LOBBIED: t ., U
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATTON (DISCLOSE WHETHER ~IOURL
FLAT RATE OR OTHER,):.
A) LOBBYIST DISCLOSURE: (Required)
~_.~_e_S~~ Are vou renresentin- a ne,t .for--r -
· - - ofitc r ora ion oreni wihouts ecialcom ens tionor
reimbursement· Pursuant to Ordinance No. 2004-3435.
Pursuant to Ordinance No. 2003-3393 Amendin Miami Beach Ci Code Chater 2 Article VI! Division 5
Thereof Entitled "Cam ai n Finance Reform" Via The Addition Of Cod~ Section 2-488 Entitled "Prohibited
Cam ai n Contributions B Lobb ists On Procurement Issues":
~LJ~~-~ present or nendin,, bid fr'r -oods. e,- ui, ,ment or service
or endln ward for ods ui men or servi e~ s or on a resent
2) Pursuant to Ordinance No. 2003-3395 Amendin Miami Beach Ci Code Cha ter 2 Article VII Division 5
thereof Entitled "Cam ai n Finance Reform" Via The Addition Of Code Section 2-490 Entitled "Prohibited
~Y_.~_e~~ Cam ai n Contributions B Lobb ists On Real Estate Develo ment Issues":
V. SIGNATURE UNDER OATH: '
ON OCTOBER Is~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE
_S~_A_T__E.I~._E_NT UNDER OATH, LISTING LOBBYING EXPENDTTHlaI:; ....... .CI'T~__CI-_ERK A SZGNED
Kit:rIVED, IN THE C M ....... , ~= WeLL A5 COMPENSATION
1TY OF MIA I BEACH FOR THE PR E
SHALL BE FILED EVEN IF TH == u~,,= ............. .r~c DZNG CALENDAR Y~AR. A STATEMENT
REPORTING PERIOD. E~L .~v= =ccfl ~DURZNG THE
Lobbyist
~[ do solemnly swear that all of the/foregoi~o~facts are~nd correct and that ! have read or am
familiar with the provision~,,c'ty~tajj~d in .~qti~In ~_-48)/9f the_~Vl' mi Beach City Code and all reporting
requirements. 0 ~/ //// /~*~7~
Signature of Lobbyist. ~
Signature of Pnnc~pal/Chent:~
vi. LOBBYIST IDENTIF:[CATION: t,/"PRTNCIPAL IDENTIFICATION:
[2 Produced ID ~ Produced ID
' 'l~Pers Form of Identification Form of identification
onally known (Lobbyist) ~'l~ersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State oi: Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn t~ and subscribed befo[e me ---.. Sworn ~nd subscribed before me
ThiS~day o.f~.~_~ ~--~:~., 2~,.~~ Thin--day of Z~_~('¢~/~. 20--~
...... or. ,ori SignatUre of Pu c Notary- State--of Iodda
~_~j~-.r,za~,on or LODDyISt'S s,gnazure.~ ..'~s$10 ;.. ~/.~ ;.=,;~. ~, ,_:__; ....... F
~_ . .... _ ~' ,,... ~.:otar.....,,.,,, u. rllilt:l al S SI nat
~ :. ~. ~ ~ .~ ?~. ~ p g ure
= :. "' :*: !1
'~.'., #DD210415 /~/
Ann al- ' /
u Kegistration fee: £~.,,~Yes [ ] No ~C .Date Paid
Lobbyist Registration Form received and verified ~,.~L~L\MARIA-M\LOBBYIST~LOBBYiST FORM 04
Revised 02/10/04 ' -