Suzanne Martinson/Pete Smith & Angela Robertson
~Sep~05-06 09:46A
P.02
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MIAMI BEACH
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
Oty 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 dty COfMlission, or a dty board or committee. The term specifically Includes the prindpal as well as any employee engaged
in lobbying activities, The term "Lobbyists- has specific exdusions. PIe_e refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) . (First) (M.I)
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BUSINESS NAME AND AODRESS (Number and Street) (atv) (State) (Zip ~) 3 ~j.fj
~~r~:!ER:?A~ 7!/?UM~!f:? t405 SMA~~~'@beJ~ I Y'it
L LOBBYIST RETAINED BY:
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NAME Of PRINQPAL/CUENT: ' ... ~A
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BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State)
,~ 57g'-- ~35S ?l?5"" 37? :3J??
TELEPHONE NUMBER: FAX NUMBER: (Optional)
33 \ ilL
(ZIp Code)
EMAIl: (Optional)
FIll out tills section If principal" B CorponItlon, hrtnershlp or Trust [Section 2-482 (e)]
· NAME OF OiIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A. 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ' 0
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5PEelFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in 'I):
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CI1Y AGENCIES/INDMDUAL5 TO BE LOBBIED:
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A) ....n Name or Individual/TItle
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B) Any FinBnc:NIl, Familial or Professional Rea.tiOnshlp
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURL Y,
Fl.ATRA7FOR OTHER):
A) LOBBYIST DISCLOSURE: (Required) tN I
:It /7~. 00
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B) PRINOPAL'S DISQOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach Oty COde Section 2-488 Entitled ~Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
o YM "0: Are YOU lobbvina on a Dresent Dr oendina bid for DODds. eauiDment or services. or on ill
, Dre5ent or oendinG award for Goods. eauiDment Dr service?
2) Pursuant to Miami Beach City Code 2-490 Entitled .Prohibited Campaign Contributions By lobbyists On Real
Estate Development Issues":
nY_ WHo: Are YOU lobbyina on a oendinG 8oolication for a DeveloDment AGreement with the CitY or
~ BDoIication for chanae of zonlna maD desianatlon or chanae to the City's Future Land Use
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3} Pursuant to Miami Beach City COde 2-484 (h) Any person (e:<cept 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..
o YM ~o: Are YOU ,.oresentina . not-for-orord: corDDriltion or entity without saecial comoensation
/ or reimbursement. .
V. SIGNATURE UNDER OA11t:
ON OCTOBER In OF EACH YEAR,. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPOIl11NGPERIOD. ~~
/' . Signature rJ LObbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
=:::'~.the prolli~ined in ~ the Miami Beach City ~ and aU reporting
Signature of Lobbyist: ~.. ~
Signature of Princlpal/Cllen ~ . . G~
VI. LOBBYIST IDENllFICAnON: PRINaPAL IDENnFICAnON: G~
o Produced ID
u Produced ID
Form of Identification
Form of Identfficatlon
)Q>ersonallY known (Principal)
;'0
X Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
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NOTARy PUBUC.STATE OF FLORID.
W Patricia B, Fisher
State of Acrida, County of Miami-Dade Co~ssion # DDS0973
Sworn _ary:l subscribed before me Expires: ~. .07, 201
This ~day of S~ 20-P Oonded Thru AllaJl1lc Bondmg Co., In,
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Signature of Public Notary - State of FlOrida -
Notarization of Prindpal's signature
State of Florida, County of Miami-Dade
Sworn to ar}d subSCribed before me
This JI'i40. dayofS~~~o~"
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SIgnature of Public Notary - State of Rorida
Notarization of Lobbyist's signature
FOR CLE
Annual Registration fee: J Yes [ J No Amount Pa'
Lobbyist Registration Form received and verified by:
F:\CLER\$ALl \MARIA-M\Lobbyist\LOBBYIST IORM
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Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
286811
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(THIS INFORMATION MUST BE COMPLETED)
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Dept: C!.-
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