Leslie V. Pantin/Arteamerilos, Inc.
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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
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 refet' to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First)
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AND ADDRESS (Number and Street) (City)
9J -7 U :.305 9 3-' 2~
(M.!)
.~I 11- ~614-.:s
(Zip Code)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
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: La s ~ V. 7A- FI , ,...)
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
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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 LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) -e--
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).--G--
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
Or;lrocurement Issues":
o Yes ~~o: Are you lobbvina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
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 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 CO URING THE
REPORTING PERIOD.
and that I have read or am
ch City Code and all reporting
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
[J Produced ID
/ Form of Identification
VPersonallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~ Produced ID
/ Form of Identification
~erSOnallY known (Principal)
Signature of Public Notary - State of Florida
Notarization of Principal's signature
Revised 12/08/04
FOR CLER
Annual Registration fee: [ Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
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