Jeffrey D. Weinstein/Robert Wennett
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MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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NAME OF LOBBYIST:
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BUSINESS NAME AND AD
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 dty 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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(Number and Street) (City)
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TELEPHONE NUMBER:
(M.I)
?1 13 ,
(Zip Code)
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FAX N~lEr.I.('fI'
~ LOBBYIST RETAIN~O II,\'
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NAME OF PRINCIPAl/CLIENT:
~-;:~AMEA~:~"~u~:r~~treet~~City) \\\\ L'~t(~ 1.J (~::~\:.{ l~
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
$~J ~1,,/e.J ~ 121.1- Lt~/" ~ 1"~AI!>>ti/
(Describe in detail): a...( ILc ~l>!'" I'( LA.. w/..
IlL CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A-Iffy. It -,,( 1.4",,,, oJ)r .
A) Full Name of Individual/ntle
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL"
FlAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
No: Are ou lobb in on a resent or endin bid for oods e ui ment or services or on a
Dresent or oendina award for ooods. eouioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Deveiopment Issues":
pites 0 No:
Are YOU lobbvina on a oendino aODlication for a Develooment Aoreement with the City or
aDolication for chan~e of zonin~ maD desiGnation or chanGe to the Citv1s Future land Use
Mao?
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 apov,e) who only appears as a representative of a not-for-profit
corporation or entity without special comper'lsation 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..
Are au re r sentin a not-for~ rofit cor oration or enti without s ecial com ensati n
or reimbursement.
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 COMPENSATION DURING THE
REPORTING PERIOD.
~'
~nature of Lobbyist
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 contained in Section 2-482 Df the Miami Beach City Code and all reporting
requirements.
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VI. LOBBYIST IDENTIFICATION:
~uced IDdr/~rI5 !Cl")ISe.
Form of Identification
~---
PRIN;Y"'L IDENTIFICATION:
~oducedlD dr/veT's /;'r"'nS~
Form of Identification
o Personally known (Lobbyist)
o Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
me KEIIRY HERNANDEZ
"lYllqlrbiSION, DO 626373
EXPIRES: May 3, 2011
BoodectThruNotalyPLtlllclJnclecwrileq
SI nature f Florida
Notarization of Lobbyist's signature
State of Florida,
Sworn..a~subs
This ..l,)"'cJay
Signa~e 0 f Florida
Notarization .of Principal's Signature
./ . FOR CLE~~NLY
Annual Registration fee: [V] Yes [ J No Am'tunt Paid . MeR # ~
Lobbyist Registration form received and verified bY~c:::t.,V~
F:\CLER\$ALL\MARlA-M\Lobbyist\LOBBYIST fORM O. c
Date Paid 'tl~1ST-
Revised 12/08/04
of ~.. ...
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
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NCR-Ci t:y' Clerk 2:38738 $155.00
288'73d
No.
CI Cash ~reclit Card CI Check #
$-' 5'5~
~~.:2.5 20S';Eb
ReceIved of ~~ W-e.J"l~\
Addre..
For---J e.
(THIS INFORMATION MUST BE COMPLETED)
By
Account Number:.Q\.\-a:x:c"'\?tlR '1#\
Pnparer: ~'" Dept:
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