Luis M. Pizzorni/Beth Sobol
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8AY M-Il~ Z:St. FL- 33/51,
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BUSINESS NAME AND ADDRESS (Number and Street) (City) I (State) (Zip Code) FI.- 33 3/?
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MIAMIBEACH
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
(./) :;?
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lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage; def~
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendatmll of ~
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel durin~e ~
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard of'Ih!vi~
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 "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF lOBBYIST:
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(last)
A.,UI S
(First)
lA GU INTtl OSA-U-<;
BUSINESS NAME AND ADDRESS
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TElEPH E NU BER:
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(Number and Street) (City)
~7) ~6.s- 9631
FAX NUMBER:
I. LOBBYIST RETAINED BY:
Ser-rr t'~. fC,{A.tMo / /Jew $fJ13tn-
NAME OF PRINOPAL/CLIENT: r
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEACIARY:
. IDENTIFY All PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II." l SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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 AMOUNlS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Ii
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Requlred).A)IJNF;,
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":
o Yes ~: Are YOU lobbYinG on a Dresent or DendinG bid for Goods. eauiDment or services. or on a
Dresent or aendinG award for Goods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes~: Are YOU lobbyinG on a aendinG aDDlication for a DeyeloDment AGreement with the City or
aDDlication for change of zoning maD designation or change to the City's Future Land Use
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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..
~s 0 No: Are YOU reDresentinG a not-for-Drofit corDoration or entity without saecial comaensation
or reimbursement. .
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 PRECEDING CALEN R YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR PENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the fore::zging fa ts are true and correct and that I have read or am
familiar with the provisions contained in Sectio 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of lobbyist: ~ ~
Signature of princiPal/Clie~ .
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
U Produced ID
U Produced ID
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Form of Identification
~rsonallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
U Personally known (Principal)
State of Flolida, County of Miami-Dade
Sworn to ag; subscribed before me
This J-o day of ~bta. 200.s-
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- Signature of Public Notary - State of Flolida
Notarization of Lobbyist's signature
State of Flolida, County of Miami-Dade
Sworn and subsclibed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
I /' It FOR CLERK'S USE O~
Annual Registration fee: [\,/1 Yes [ ] No Amou Paid /Jl.)J- '/0 (~~R #
Lobbyist Registration Form received and verified bY:.~ P.P-( ~+ <<~"'~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 . oc
Date Paid I
Revised 12/08/04