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Sherry R. Joseph/A. Romel Joseph - Walenstein Musical Organization m ..... MIAMI 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. NAME OF lOBBYIST: 3 h ~ ~SINESS NAME AND ADDRESS @~ b~lt-~Y TElE ONE NUMBER: ~1, f\1 ram; ~h 33/ q ~Uf>e- FAX NUMBER: (Stat (Zip Code) r~jA~..h @ n-tsn,Ltrn1 I. LOBBYIST RETAINED BY: A. Rt7m~1 NAME OF PRINCIPAl/CLIENT: Jese-ph D_' . . FL- fzahen '/-Vb IJu) IIt/5 SJ-.ra. B~/, H'aJ1J' 13316~ Street) (City) (State) (Zip Code) ~k,~ fvWs(~1 BUSINESS NAME AND ADDRESS C~ffJO~~~Ef5S3 (Number a 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. SPECIFIC LOBBY ISSUE: CuJ fwut, Grwd- se/;~ .J.alz';'" t8r U Issue to be lobbied (Describe in detail): ~A- L; ~. III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship N(~ &OJ fu./fuMJ- lJf1f.t/fS ~ I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ ; 1'6/ ht'. , :# I '6/ hi I 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 lobbying on a present or pendina bid for goods, eQuipment or services, or on a present or pending award for goods. equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~o: Are you lobbYing on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 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 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING 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. P.. ~ ~~n_~ / Signa e of bbyist 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 tained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal! VI. LOBBYIST IDEN1FI~TI~N: "- vroduced ID ( ~ a h~ Form of Identification FICATION: .. jJ-. ;J () <-('.,~~~~ Identification o Personally known (Lobbyist) [J Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn t . This State of Florida, County of Miami-Dade swor~.n a[J; subscri This ) day f , Signature 0 Publi 18 Notarization of Principal's signature ... FOR CLERK'~ U~E ONLY /]... ~ '7c... Annual Registration fee: [ ~ ] No Amount Paid ,5 ?' MCR # f '6 Y' I 0 ? Date Paid Lobbyist Registration Form received and verified by: ~ ~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM'QSJdoc Revised 12/08/04