Berton G. Weiss/Berton Weiss
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MIAMIBEACH
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 lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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E OF LOBBYIST: (Last) (First)
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(Number and Street) (City)
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FAX NUMBER:
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M (Zip Code)
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EMAIL:
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I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
(Zip Code)
BUSINESS NAME AND ADDRESS
(City)
(State)
TELEPHONE NUMBER:
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:
U. SPECIFIC LOBBY ISSUE:
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOROTHER): ~.
A) LOBBYIST DISCLOSURE: (Required)
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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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 TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS W COM ATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CAL AR Y ATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU OM ATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoin
familiar with the provisions contai I
requirements.
Signature of Lobbyist:
VI.
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./ FORe USE ONLY
Annual Registration fee: [V] Yes [ ] No Amount p'ai ,r:;:- MCR # ~FB
Lobbyist Registration Form received and verified by: D )f"'~
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM 05:4oe' r
Date Paid 5j (q[ Q,p
Revised 12/08/04
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
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rS' Cash 0 Credit Card 0 Check #
Received of
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For
(THIS INFORMATION MUST BE COMPLETED)
By
Account Number: C)\ \ - 8ca') ':3(cq~
preparer:,J ~~~ Dept: C:i.:
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287193
No.
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