David Whitaker/GMCVBMiAM!BEACH
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 derision 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 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) (First) (M.I)
Ooc~V~ q-~ ~r,~l f4v~. 6Jrt. o~~ /dio~l~'LJSL~I
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMA~L:
LOBBY/ST RETAZNED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (CiW)
(Zip Code)
-o &o
FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. UD; l;ant
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
v'O. GraF'ri-
Issue to be lobbied (Describe in detail):
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
dioM
B) Any Financial, Familial or Professional Relationship
IV. ' DZS~LOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATZON (DZSCLOSE WHETHER HOURLY~
FIN T RATE OR OTHER,):.
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-4813 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
[] Yes,.No: Are you Iobb¥inq on a present or pendinq bid for qoodsr equipment or services, or on a
present or Dendinq award for qoods, equiument or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
[]Yes ~l('No: Are YOU Iobb¥inq on a uendinQ application for a Development Aqreement with the City or
· ' application for chanae of zonincl map de$iqnati0n or chanqe 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 reoresentin~ a not-for-orofit corooration or entity without soecial compensation
pr reimbursement..
v. S:[GNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, I..ZSTZNG LOBBYING ~-X4~NDZI'URES, AS WELL AS COMPENSA'I'ZON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PR~L~EDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO~ EXPENDZi~RES OR COMPENSATION DUI~NG THE
REPORTING PERIOD. :, ~
' Signature of Lobbyist
! do solemnly swear that~he foregoing facts are true and correct and that ! have read or am
familiar with the provisio~ conta[h~d in Section 2-482 of the Miami Beach City Code and all reporting
requirements. J '~ ' ~
Signature of Lobbyist: ! .J ~ '~- '-~
Signature of Principal/Client:
VT. LOBBYIST ZDENTZFZCAI'ZON:
PRINCIPAL '[DENTZF'ZCAI'ZON:
[] Produced ID
Form of Identification
~/ Personally known (Lobbyist)
[] Produced ID
Form of Identification
[] Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to ~a~j:~ subscribe~l before me Sworn and subscribed before me
This ~='2'] day of ~ ,C~bi(_/d~, 20Ot~ This day of ,20~
~ ~' ~~~ '~_~_Ton,.,~.. .... .
S~nature of ~blic No~ - S~te ~~ ~. ~,o,~ ~11~ature of Public Nota~ - State of Florida
No~rization of Lobbyist's signa~~ ~p,res ~ ~, ~ No~rization of ~rincipal's signature
Annual Registration f~: [ ] Yes [ ] No ~ount P~ ¢) I~ ~ ~ ~ __/ Date Paid ~ ~ U~
Lobbyi~ Regi~ation Form receiv~ and verifi~ by: ~A~; ~ /
F:~CLER~$ALL~HAR~-N~Lobbyist~LOBBY[~ ~RN 05.doc ..... -/ ~" ' ~ Revis~ Z2/08/04