Alexander Tachmes/Wilmslow USAMIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, IVliami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lolat~yist 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, resol,Jtion, action or decision of any commissioner; any action, decision, recommendation of the
City Mar. ager or any city board or :ommiUee; or any action, decision or recommendation of any city personnel dur'mg the time
period of the ertir~_ deds;on-making process on s,Jcq action, decision or recommendation that ?oreseeably will be heard or reviewed
by the d~ commission, or a city board or committee. The term specifically includes the orindpal as well as any employee ertcy~jed
~a lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LO3BYIST: (Last) (First) 0'1.I)
P, le,~,**o,~ -Z. Tm.t_J,,,~_ P.A- g~ ~.~,~¥~a f'd~¢a. ~_-~_. t.L.~ ~--- $~:t t
BUSINESS NAME AND ADDRESS / (Number and Street) (City) ~ (S'l:ate) i (Zip Code)
/~LEPHONE NLMBER: FAX I'~UMBER: FMAIL:
ir. LOBBYIST RETA[NED BY:
NAHE OF PRIN~PA~C~ENT:
BUS[NE~ NAME AND ADDRESS (Number and Street) (City) ~ (State) ~
TELEPHONE NUMBER:
:AX NUMBER: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER. OR BENEF.?C]~RY: ~'~'~f~-- --~"'~'~q)
IDENq"IFY ALL PERSONS -IOLDIXIG, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INT~ IN SUCH
Issue tc be lobbied (D~-scribe
IlL CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
I_B) Any Financial, Familial or Professional Relationship
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~V. pZSCLOSURE OF TERPlS AND AMOUNTS OF LOBBYZST COMPENSATION (DZSCLOSE WHETHER HOI./R£ ~
FIji T ,RA TE' OR OTI'tER):
A) LOBBY[ST [3[SCLC)SURF: (Required~ __.~ ~_ ~' //~1~O~
B) PRIN£]PAL'5 DISCLOSURE (OF LOBBYIST COHPENSA-F[ON): (Required)._-~ 3 {f ~f
_ . .
The following information must be answered:
1)
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions Oy Lobbyists
On Procurement ]:ssues":
C3 Ye.s I~N, o: Are you Iobbvina.o.n a present or pendinq bid for qood~;t eauioment or services, or on ~
oresent or peqding aw,a. rct for qqocls, eauiom, ent or servi;e?
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues'":
3Yes .J~xN o:
Are you Iobbvinq on a oendinQ ao. plication for a Development Aare~ment with the CiW or
aoolication for ~hanqe of zoninq map desiqnation or chanqe to the City's Future Land Us~
Map?
3)
Pursuant to Miami Beach CiL3' Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth i.q 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 bhls
section but:, shall not be requ;red to pay any registration fees..
[] Yes J~No: AreoFreimbursement.VOq representinq, a not-for-profit corporation or entity without soecipl cqmpen~ation
V, SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR~ EACH LOBBY]ST SHALL SUBMTT TO THE C2TY CLERK A SIGNED
STATEMENT UNDER OATH~ L:[ST~NG LOBBYING EXPENDTrURES~ AS WELL AS COMPENSATI'ON
RECI:1VED~ TN THE c]-rY OF MTAMT BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEMENT
SHALL BE FZLED EVEN IF THERE HAVE BEEN NO ~~ON DUR. JNG TIlE
REPO R'r~NG PER[OD.
Signature of Lobbyist
Signature of Prindpal/Client:
LOBBYZST ZDENT[F[CAT~Ofl:
:"i Produced ZD
Form of Identification
[ do solemnly swear that all of the foregoing facts are true and correct and that I have read or arn
fern]tier with the provisions con~a~'ned in Section 2_:.4~ of the rvliami Beach City Code and all repo~ting
requirements.
Signature of Lobbyist: .
PR~NCLPAL :DENTEFTCATION:
Form of lde~tification
'j~e~onalJy known (Lobbyist) .. Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Flor;da, Couqty of HJami-Dade
Sworn to and subscribed before me _ Sworn and subscribe~. ~efor~41~le
..~ ,,. This --~.') day ofl:e~..~ , 26~/~-~ This ~_a~day of
~,~,.....~ I~~/ 7 ~
,,~~ ~~ota~- State of Florida Signature of~ic~e ~'~
-:~,:~ . . ..... - .. .
~ ~,¢ ~~~~~~ur e Notarlza~on ~ P nnd~l's s;gn~ure
Annual ~%atio~?~?~Bu~ ~'~"~ NO Amount P~j~ ~ HCR ¢ ~ ~/Z ~ Date Paid
Lobby~t RegistratJcn For~ received and ved6~ ~: ~~
F:~CLER~LL~R~-H~L~byistkLOBBY]ST ¢ORH 05.~
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Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
[] Cash riP'edit Card []Check #
Address
No. 281 75~
$, _..-/o
/~- 20~
,-'
nce Director
(THIS INFORMATION MUST BE COMPLETED)
Account Number:
Dept: