Jimmy Morales/The Smith & Wollensky Restaurant Group
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M~AMI BEACH
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, 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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NAME OF LOBBYIST: (Last) (First)
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TELEPHONE NUMBER:
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(State)
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(M.!)
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(Zip Code)
~C>S- 7r~- 3~ <\ S"
FAX NUMBER:
EMAIL:
I. lOBBYIST RETAINED BY:
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NAME OF PRINCIPAljCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
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(City)
A rJ Sf; I J,4I1 ~ AI
I Ot:>~ I
(Zip Code)
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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: A LAt0 st ~ \ \ p... ~IJ
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~'b~ ct...
II. SPECIFIC lOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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 TER~ ND AMOUNTS OF LOBBYIST COMPENSATION (r LOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ----I:}Ot.t~{ 113$0.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)._Hou,t L( ~ 35'0 . DO
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":
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";
DYes
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..
DYes
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 CALENDA EAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND URES OR COMP SATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts
familiar with the provisions cant ned in Section 2-
requirements.
Form of Identification
~nallY known (Lobbyist)
0"Personally known (Principal)
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State of-i=leFida, County of Miami Dade ;ea.zco: ;
Sworn and s.ubscribed before me r: :aJ.
This /7-/fldayof UIt~cH . 20{2fp .g 8
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lY1/H.l1L U.
Signature of'p~ic-Notary - State of . NE~ y".et<.
Notarization of Principal's signature
Produced ID
PR~~~ENTIFICATION:
o Prod~
Form of Identification
SIGNATURE AND STAMP OF NOTARY:
te of Florida, County of Miami-Dade
orn/o and subscribed before me
s w.hv dayoff1;t.2M..tV.. 20J!.../'
10
19nature of Public Notary - State of Florida
Notarization of Lobbyist's signature
/ FOR CLERK~SE ONLY
Annual Registration fee: [ V) Yes [ ] No Amount Paid \ ...co MCR #
Lobbyist Registration Form received and verified by: .....,
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.
Dat Paid \\J2S b(o
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00 Revised 12{08{04