Adrian Raymond/Unidad of Miami Beach - Margarita Cepeda
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MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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, dedsion 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 lobbying activities. The term "LobbyistsH has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
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(Last)
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(Number and Street) ! (C~) (State)
G 7 - OOJ~- I l.3Ds 8"67- DOS 1-
FAX NUMBER: EMAIL:
(M.I)
33 jlfl
(Zip Code)
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LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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(City)
803-
FAX NUMBER: (Optional)
bepc~
jJ'b~ I G~~J,- FL
(State) (Zip Code) 33l L} I
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EMAIL: (Optional) ;$10<
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BUSINESS NAME AND A
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TELEPHONE NUMBER:
PBS;Jo ~:m~f,;~i
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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:
SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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II.
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF L BYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FlATRATE 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 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues";
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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..
v. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT T
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITUR
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED G
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT ES
REPORTING PERIOD.
THE CITY CLERK A SIGNED
WELL AS COMPENSATION
ENDAR YEAR. A STATEMENT
COMPENSATION DURING THE
I do solemnly swear that all of the for:
familiar with the provisions contained i
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST ~FICATION:
o Produced 10 ~ c' 10 \Le... T D
Form of Identification
ing facts are true and correct and that I have read or am
ection 2-482 of the Miami Beach City Code and all reporting
PRINCIPAL IDENTIFIfAytON:
D Produced 10 ~ I c.+ Ji2_~ I' b
Form of Identification
o Personally known (Lobbyist)
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
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Signat re of Public Notary - State of Flonda
Notarization of Principal's si nature
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State of Florida, County of Miami-Dade
Sworn to and subscribed before ,me
~.'1 day of 1\ K" , . 20 " \0
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Signature O~PUbliC Notary - State of Florida
Notarization of Lobbyist's signature
FOR~K'S USE ONLY N('i
Annual Registration fee: [ ] Yes [ ] No A~nt~1-- MCR" ___.'
Lobbyist Registration Form received and verified by!;--- _~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM M.CJoc ;/ "'J
Revised 12/08/04