Terry De Carlo/Wade Patterson
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M\IAMIBEACH
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
in lobbving activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME UF LOBBYIST:
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BUSH,JESS NAME AND ADDRESS
(Last) (Fils\)
3s(C) S( SC1'iN C ~,t..~
(Number and Street) (City)
Jc,r --.5-7(- (~C~
FAX NUMBER:
(M.!)
3D$' /s7{,- i?.:J<j ..l; 2(0
TEFE!" w'NE NUMBER:
su (ce- 300
(State)
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EMAIL:
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(Zip Code)
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I. LOBBYIST RETAINED BY:
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NMI'F PRINCIPAL/CLIENT:
C.,fAe Ac-J(Y;'u'lCE' JS(6 {SrSci'O./c {5(,0..1
BUSHEe;s NAME AND ADDRESS (Number and Street) (City)
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TELE! ,ONE NUMBER: FAX NUMBER: (Optional)
sunt .s,'f..> 1/{l,AM /, FL :J.7 I .:J rr
(State) (Zip Code)
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EMAIL: (Optional)O-.tG-
Fill ("" this section if principal is a Corporation, Partnership or Trust: . "on 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:
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Iss'" be lobbied (Describe in detail):
In. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
I
A) r,,"' Name of Individual/Title B) Any Fin~: ' ;'1, Familial or Professional Relationship
tH. F("J OE LA CUfJA;; CA.A: .vij'
( . ..1.\ O,M. I,.JJ[tt)/ltfl
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IV. DISClOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMpr'.,c "TION (DISCLOSE WHETHER HOURLY,
F' ~ 7 '? A TE OR OTHER):
A) ["fWIST DISCLOSURE: (Required)
B) Pi'IJCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
SAcM Y
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Tr,f' f"lIowing information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Pmhihited Campaign Contributions By Lobbyists
On Procurement Issues":
bLYps j(No: Are YOU lobbyino on a present or pendino bid fo.r:"~0nds. eouipment or services. oron a
present or pendino award for ooods. eouiprn'~n:"rvice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohillltf' i I' npaign Contributions By Lobbyists On Real
Estate Development Issues":
bY"" 'Mo: Are YOU lobbyino on a pendino application fOL;)" .'''Iopment Aoreement with the City or
application for chanoe of zonino map des!(Jf' ., hanoe to the City's Future Land Use
Map?
3)
Pursuant to Miami Beach City Code 2-484 (h) Any pet'SOll
"lobbyist" as set forth in Section 2-481 above) who C,.ly
corporation or entity without special compensation or rei;;,:'
indirect, to express support of or opposition to any item, '
section but, shall not be required to pay any registratioll t
(I'xcept those exempt from the definition of
','5 as a representative of a not-for-profit
"nt for the appearance, whether direct, or
:<'gister with the clerk as required by this
Jfl..v."c !] No: Are YOU representino a not-for-profit corpQr~'" '. .'ntitv without special compensation
or reimbursement.
V. SIGNATURE UNDER OATH:
0'" nCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SH.'.,LL .
S - '''1ENT UNDER OATH, LISTING LOBBYING EX
P 'lED, IN THE CITY OF MIAMI BEACH FOR THE P
S ' BE FILED EVEN IF THERE HAVE BEEN NO E.
P 'TING PERIOD.
"IT TO THE CITY CLERK A SIGNED
S, AS WELL AS COMPENSATION
CALENDAR YEAR. A STATEMENT
OMP ATION DURING THE
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correct and that I have read or am
ii Beach City Code and all reporting
5i I.' ure of Lobbyist
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LOBBYIST IDENTIFICATION:
: ')ENTIFICATION:
Produced 10
D
Form of Identification
Form of Identification
Y Personally known (Lobbyist)
vn. SIGNATURE AND STAMP OF NOTARY:
XP,.r'
known (Principal)
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Revised 12/08/04
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