Allan Schulman/Savoy Hotel City of Miami Beach Office of t~e 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.
Shulm n RIl n
NAME OF LOBBYIST: (Last) (First)
llon'r. shulman
BUSINESS NANE AND ADDRESS (Number and Stre~ (Ci~)
TELEPHONE NUMBER:
FAX NUMBER:
I. L~lil~I~ RETAINED BY:
NAME OF PmNCIPA~C~E~: //
BUSINES~ ' ~D ADDRESS (Numar and Stm~ (Ci~) ' / ' (State)
(Tip 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:
II. SPECIFIC LOBBY ISSUE:
Issue to be Iobtlied (Describe in cl~tail):
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
ZV. DI'SCLOSURE OF TERMS AND AHOUNTS OF LOBBYZST COHPENSATZON (DZSCLOSE WHETHER HOIJRL~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following informaUon must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes ~.o: Are you Iobbvin(3 on a oresent or oendincl bid for Qoods, eouiDment or services, or on a
present or oendina award for (3oods, equipment or service?
2) Pursuant to Miami Beach City Code 2-~90 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~C~o: Are you Iobbvinq on a oendinq am)lication for a Develooment Aqreement with the City or
at)olication for chan(3e of zonina mad desk3nation or chanae to the City's Future Land Use
MaP?
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 ~1o: Are you representinq a not-for-profit corporation or entity without special compensation
Qr r~imbursement. ·
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR~ EACH LOBBY]ST SHALL SUBMZT TO THE CZl'Y CLERK A SZGNED
STATEMENT UNDER OATH~ LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATZON
RECEIVED, IN THE CZl'Y OF MLAM] BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURZNG THE
Signature of Lobbyist
T do solemnly swear that all of the foregoing facts are true and correct and that T 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 Prindpal/£1ient:
VZ. LOBBYIST IDENTiFICATiON: PRZNC~PAL IDENT~F~CATZON:
i~ Produced IDff/
Form of Identification Form of Identification
[] Personally known (Lobbyist)
[] Personally known (Principal)
State of Flodda ,"~,1~-~_M~m~-n;~lp __. _. .... S~te of Florida, ~un~ of Mi~
~~t~d s~,s~~fore ~AVlER A. LEY-SOTO '
~is / d~ ~'~. ' ~] State of F~a
t~ )~~~m~~esMar/,2~~
5~ur~°~ Pub'c ~~ ~t.~,~n~N°a~ ~. ~ Sig~~ Public N~~e ~FIorida .
No~rizaUon of LobbYi~s signature .... mo~r~z' "-'--'-aUon of Principal's signature
Date Paid
Revised 12/08/04
FOR.CLERK'S_USE ONLY
Annual Registration fee: [IL~].y~ ]No .~,rno~nt Pa~:~
Lobbyist Registration Form received and verified b3rt~l~-----~
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