Jimmy Morales/Solomon ZalmanMIAMIBEACH
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 prindpal as well as any employee engaged
/n lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF' L6BBVIST: - (Last) (First)-( (M.I)
S - .rns~J~O~.r ,'ll c Sr.
BUSINESS NAME AND ADDRESS / (Number and Street~ (City)) ' (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER:
EMAIL.'
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLiENT:
BUSINESS NAME AND ADDRESS
TELEPHONE NUMBER:
(Number and Street) (City)' (State) (Zip Code)
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:
~ssue' to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIViDUALS TO BE LOBBIED:
lA) Full Name of Individual/TiUe
B) Any Financial, Familial or Professional Relationship
L/FO
DTSCLOSURE OF TERMS AND AMOUNTS OF LOBBYTST COMPENSA'rZON (DTSCLOSE WHETHER HOURL ~
FI. AT RATE OR OTHER,):.
A) LOBBYTST DISCLOSURE: (Required) ~ ~ ~_~__~' ('~
] ' ,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSAT[ON): (Required). ~ ~ ~,~fqJ'~,._.
The following information must be answered:
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
[] Yes I~No: Are you Iobbyinq on a present or pending bid for g0ods~ equipment or services~ or on a
/-
oresent or nendinq award for qoods, equipment o~ service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
OYes ~No: Are you Iobbyinq on a pendinq application for a DeVelopment Agreement with the City or
/
application for chanqe of zoninq map designation Or chance to the City's Future Land Use
MaP?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person Cexcept 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 .E~io: Are you reoresqntinq a not-for-profit corporation 0r entity without sPecial compensat;i0n
/
or reimbursement..
V. SIGNATURE UNDER OATH:
ON OCTOBER is'r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATHs, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALE~IDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IR 171, ERE HAVE BEEN NO EXPEI~iDTI'URES OR (~(OMPENSATION DURING THE
REPORTING PERIOD.
ture of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiarrequirements.With the provisions contajJned in Se~ 2-482 of the Miami Beach Ci~ Code and all repo~ng
Signature of Lobbyist:
vi, LOBBYIST IDENTIFICATION: PRTNCIPAL IDENTIFICATION:
~' Produced ID ~/~ t ~j/~ ~1
Form of Identification Form of Identification
[] Personally known (Lobbyist)
[] 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 and subscribed before me Sworn and subscribed before me
This f/~/~ day of ,~k"/~'~~01;~cl Jack Kir~ Jr This/7 ~day of
' ~:~~______.~ _ ]~' ~ Commission DD124044 ~ ~,'~,'~- Donald Jack Kimnach Jr
Signature of Public Notary - St~'~ of FT~ri~- ' Signature of Public~~.~._~tate o~ Expiree
Notarization of Lobbyist's signature Notarization of Principal's signature
, ~. FOR CLJ~!:~. ~.~, US~ONLY
Annual Registration fee: [ ~ Yes [ ] No AmountiP~j~, ~"/~./90 MCR #~/2 2//Y ~/~Date Paid
Lobbyist Registration Form received and verified by: /~'~../~"~- - - -
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYJST fORM 05.iJ~c' ' Revised 12/08/04