Jimmy Morales/Smith & WolenskyMIAMIBEACH
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 spedfically includes the principal as well as any employee engaged
/n lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435,
NAME OF LOBBYIST: (Last) (First)
BUSINESS NAMJ~ AND ADDRESS; (Number and Street) (~ty)
TELEPHONE NUMBER: FAX NUMBER:
(State)
(M.I)
(Zip Code)
EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City)
TELEPHONE NUMBER: F~ NUMBER: (Optional)
(StYe) (Zip 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:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~ ~
II. SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CTTY AGENCIES/INDIVIDUALS TO BE LOBBIED:
IA) Full Name of Individual/Title
B) Any Financial, Familial or Professional RelaUonship
otHeRS.
A) LOBBYIST DISCLOSURE: (Required)--
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
The following information must be answered:
DISCLOSURE OF TERMS AND At4OUNTS OF LOBBYIST COF4PENSATZON (DISCLOSE WHETHER
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
[] Yes ~No: Are YOU lobbying on a present or pendinq bid for qoods, equipment or services, or on a
present or Dendina award for ~oods, eouiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
E]Yes I;~o: Are you Iobbyinq on a pendinq application for a Development Agreement with the City or
application for chanqe of zoninq map desiqnation or change to the CitY'S Future Land Use
Mao?
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 reoresentina a not-for-profit corporation or entity without s~ecial compensation
or reimbursement..
V. SIGNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR~ EACH LOBBYIST SHALL SUB,lIT TO THE CITY CLERK A SIGNED
STATEt-tENT UNDER OATH~ LTs'rZNG LOBBYING EXPENDZTURES~ AS WELL AS COlUlPENSATION
RECEIVED~ IN THE CITY OF t4IAt-lI BEACH FOR THE PRECEDING CALENDARzcYEAR. A STATEf4ENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDitURES OR COPlP/E~SATION DURING THE
REPORTING PERIOD. J__~.~_~ {
I Sig_ nature)f I~bbyi~
I do solemnly swear that all of the foregoing facts and cor~ct and that I have read or am
familiar with the provisions ned in Section Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
LOBBY/ST IDENTIFICA'rZON:
[] Produced ID
Form of Identification
~ersonally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
of Florida, County of Miami-Dade
and subscribed before me
of .'TBS_ ~,20/2~
)N:
Form of Identification
9~/Personally known (Principal)
gnature of Public Notary - State of Florida
State of-F-ler-i~, County of ~
Sworn and subscribed before me ~'~
This /7'/~day of //-~4,~C/~ · 20~_.~
Signature of'Pu/olic Notary - State of~ ~/~J
Notarization of Lobbyist's signat~ure Notarization of Principal's signature
· ~ FOR CLERi~'SJ,IS~,ONLY ', //?' ~ Pa'dZ i,~,~
Annual Registration fee: ~ Yes [ ] No Amount~'~ MCR ~-~, P//'~'~ Date '
Lobbyist Registration Form received and verified by: ~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05~c / ~ Rewsed ~2/08/04