James MacKenzie/81st Street Partners
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MIAt\I\! BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA TION 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.
,
"' Jl)Uid I4Ack'E AlL ~
~ME OF LOBBYIST: (Last) (First) . . JJ (M.!)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) .
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ELEPHONE NUMBER: FAX NUMBER: EMAIL: ~ ~A ;J1'i, ~/.
I. ~YIST RETAINED BY:
/.5/ /~R?7I/py1~ t.C C.
NAME OF PRINCIPAL/CLIENT:
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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
III. CITY AGENCIES/INDIVIDUALS TO BE lOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
do.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) {j?vi
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPE SATION): (Required). ~Z.r-. -- I/r-.
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";
DYes ment or services or on a
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 EXPENDIT
RECEIVED, IN THE CITY OF MIAMI BEACH FOR T RECE ING
SHALL BE FILED EVEN IF THERE HAVE BEEN N EXP NDITU
REPORTING PERIOD.
I have read or am
de and all reporting
"
I do solemnly swear that all of the foregoing
familiar with the provisions contained in Sectio
requirements.
Signature of Lobbyist:
Signature of PrincipaljCli
VI. lOBBYIST IDENTIF TION:
~oducedID :!k1Ah~ f~
Form of Iaentification
r~duced ID
Form of Identification
o Personally known (Lobbyist)
C= Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
FOR CLERK'S USE ONLY - - ~ b
An"",' Reg,,,,,,,," f,,, [ . ,<" [ ] No Am""t.)'j.~"'.r-s - t'~CR # , fi It -?vl Date Paid t?-: J; t/
Lobbyist Registration Form Ve'~ei~~d and verified by:. '-L
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM oS.dc c . 2 'S 61.t L (I"l: (i evised 12/08/04
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