Allan Shulman/Ocean FairwindMIAMIBEACH
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
//7 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) (City)
TELEPHONE NUMBER:
(State) (Zip Code)
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F~ NUHBER: EHAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
~o 5'- ,l q'o ' /) 3 q ~ c9OS" riO'3 - 0 3 ~ ~
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(Tip 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: ~/--/~1 ~ ~' ~~'/V'j ~ ~/~' i~ ~i1~
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIPORTRUST: ~ ~. ~ ~.1~',,~1,~ ~. il~ ~ ~ O /~l~".-~ t
II. SPECI~C LOBBY ISSUE:
[~ue to be lobbied (Describe in detail): pO~ p~I~MI~ ~T~ ~
~I. ~ AGENCZES/ZND~DUALS TO BE LOBBIED:
IA) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATION (DI'SCLOSE WHETHER
FLAT RATE OR OTHER, I:
A) LOBBYIST DISCLOSURE: (Required) [+C:~r_~ ~ /,,"~:~L-~r~'~,, '~ [~::X:~ /
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSA'r]ON): (Required). ~ 14JIP,,~ i~--~,- /lq~il/~._~
The following information must be answered:
l)
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
[3 Yes~2~lo: Are you Iobbvina on a oresent or pendinq bid for qo0ds~ equipment or services~ or on a
~ ' present or pendinq award for qoods, equipment or service?
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Tssues":
DYes ?~'~ No: Are YOU Iobbvina on a oendinq application for a Develooment Aareement with the City 9r
aoolication for chanae of zonina mad desianation 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..
[] Yes ~/No: Are you reoresentinq a not-for-orofit corooration or entity without soecial compensation
'~' or reimbursement;..
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYI'ST SHALL SUBMTF TO THE CZTY CLERK A STGNED
STATEMENT UNDER OATH, LISTZNG LOBBYI'NG EXPENDTTURES, AS WELL AS COMPENSATI'ON
RECEZVED, ZN THE CI'TY OF Mi'AMI' BEACH FOR THE PRECEDTNG CALENDAR YEAR. A STATEMENT
SHALL BE Fl'LED EVEN 1'F THERE HAVE BEEN NO EXPENDTTURES OR COMPENSATION DURING THE
REPORTZNG PERIOD.
Signature of Lobbyist
! do solemnly swear that all of the foregoing facts 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
requirements.
Signature of Lobbyist: ~//~"7~ ~__~'~/~ ~
~ ~ P~CZPAL
TDENTZFZCATZON:
II Produced ID
Form of Identification
t:~ersonally known (Principal)
Signature of Principal/Client:
LOBBYZST IDENTJ:F]:CATJ:ON:
~;.I Produced ID
Form of Identification
[. P~ersonally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
VII,
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
SignatUre of Public Notary 2 S~a"~e of Florida ~"
Notarization of Lobbyist's signature
My CommissIon DD148455
Expires October 28 2006
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This It~, 20i~ (/e/~
Signature of Public Notary - State'of Florida
Notarization of Principal's signature
/ FOR CLEI:CK,'SJJSE ON LY / / //~,~/,,~/~/~::, I
Annual Registration fee: [ v/J'Yes [ ] No Amount Paid. _~ ~/,~'- MCR # ~T ~-//_.~/~' Date Paid /
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc'/~-'"~ Rev~sed'l~./08/04