William Vela/Miami Short Film Festival
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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
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)
2501 J3r/Clcef/ 4 V
BUSINESS NAME AND ADDRESS (Number and Street)
30.r-864-~Jq
TELEPHONE NUMBER:
WILL;AM
(first)
5tJ,fe roo 8 fJ1IAM/ {:"L
5
(M.I)
3 "51d-cr
FAX NUMBER:
(City) (State) (ZIp Code)
WlltAAft/J e fYJ/AM/.shoet j::"(LwJ FES7/U4G Cot
EMAIL:' .
I.
LOBBYIST RETAINED BY:
H If\M i S hoeT r-'L~
r~~p' LJ A L
NAME Of PRINCIPAL/CLIENT:
~501 Bn'C~e
BUSINESS NAME AND ADDRESS
I
tJ. V SU (f .JJ- ((;08' M 1'1 ft11
(Number and Street) (City)
fAX NUMBER: (Optional)
~lJ;q
(State)
33/J
30 - ~S4-
TELEPHONE NUMBER:
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. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndiVidual/Title
c.
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURi Y,
FLAT RATE OR OTHER):
~(A
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A) LOBBYIST DISCLOSURE: (Required)
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":
D Yes ~o: Are YOU lobbyina on a present or pendina bid for aoods. eauipment or services. or on a
present or pendina award for aoods. eauipment or service?
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~o:
Are YOU lobbyina on a pendina application for a Development Aareement with the City or
application for chanae of zonina map desianation or chanae to the City's Future Land Use
Map?
DYes
3)
Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" a~ set forth in Section 2-481 above) who only appears as a representatjve of a not-far-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..
Yes D No:
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 CALE,AR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE DITURES OR C P.ENSATIor:URING THE
REPORTING PERIOD. _1\ '
l;V~ . ~\
Sign ture a a
VI.
L~YIST IDENTIFICATION:
~roduced ID tit-'u~ 1L:/~t
I Form of Identification
e an correct and that I have read or am
iami Beach City Code and all reporting
I do solemnly swear that all of the foregoing facts ar
familiar with the provisions co ained in Sectio 2-482 of
requirements.
Signature of Lobbyis .
Signature of Principal/Client:
PRINCIPAL IDENTIFICATION:
!~UCed ID I~i--t'u[; tc~
Form of Identification
o Personally known (Lobbyist)
!~ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
tate of Florida, C
worn a!1gsubscr .' u"':...e me KEflRYHERNANoEZ
iS~:tIaY of . . ';1~MtlSION # 00626373
-> EXPiRES: May 3, 2011
(I- /l U 8eI1ded Thru Notary PUblic UndelWlftera
Signature fYublic Notary ~ 0
Notariza ion of Principal's signature
FOR CLERK'S. SE ONLY .
Annual Registration fee: [ ......}'f'es [ ] No Amount Pa' MCR # ///--~
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.do.
Date Paid