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Robert Goodman/J. Handy m ~ 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, dedsion, 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 spedfically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Gt:YY///RO ./ft~f-J NAME OF LOBBYIST: (rast) (First) ~fk/" ..t r;;;,rrVnr7~ //~/Iis.wa~, BUSINESS"NAMEAND ADDRESS (Number and Street) J(city) Ut. - /.2l./- ~ AX NUMBER: .....5: (M.!) ,_-{aLL!l-.E!S~ Ib/~ ,/JfJ~/J A' ):L (State) (Zip Code) $/.ljt/ I. LOBBYIST RETAINED BY: , J. 4,~ NAME OF PRINCIPALjC ENT: BUSINESS N hJ"1~%~-gi()(] (~LEPH E NUMBER: (Numb nd Street) (City) {d; /);) %~ - 9'7ho F 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, DIREffiy OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ' II. SPECIFIC LOBBY ISSUE: IV!/am> ,4ri,h (J,/JvP/7ir~n (?r'Oj;,A rI;zk~ Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship dm~o/) <>tAlm//isJrcz/,;tJr) .A0/Je IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURi Y, FLA T RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) -4 "fmo r"1/}/J//;:;J ~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).~(J/)() ;:7/7/7/./ (7/ ";;0 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 se ion but, shall not be required to pay any registration fees.. V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH L08BYIST SHALL SU8MIT TO THE CITY CLERK A SIGNED . STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THEYRECEDING CAJ.ENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN ITURES 0 COMPENSATION DURING THE REPORTING PERIOD. ~# ,-1 A _____ I / Signatur -(obbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions c ained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: VI. PRINCIPAL IDENTIFICATION: XProduced IOn J1/vprs 1;o./15e- P n<t -Form of Identification tt- cruO~-r1 '3o;;)- [] Personally known (Principal) 'r/J Produced 10 l JI./': ?~r:: Form of Jste~t:jfication -L1-.JJJ -777 S'l-3u~-() [] Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: o~ ~'"""~c-~~v- State4.EJ.orida, C-ounty"'Ot'MtamFOade Sworn and subscribed b~ore me This h-day of ~u~ 20~ State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 20_ Signature of Pub Notarization 0 Signature of Public Notary - State of Florida Notarization of Lobbyist's signature / FOR CLEI!K'$.J.ISE ONLY /} () 7 ()' C I Annual Registration fee: ] Yes [ ] No Amount p~a'dfl. r /7:; MCR # <~ ..r / J I Date Paid '1 I Lobbyist Registration Form received and verified by: . _ ~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM os.DO'C ' Revised 12/08/04 0( Z 8 ~ :c~ >- .25~ :2 :g81l Z-la..ctiE III US ~:e ~ 1l.U)2a..o lL. -J 0 _2: o ~ ~~ ~ J: ex::2 a.,~ ~ ~~~$ <( Oal=c W 2:>--c 0 ~ ex: a.. in Z <( 15 ,!!! o c.9 >,E ~ 88 u o >- u ~