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MIAMIBEACH
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. 'CitY of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passc:lge, 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:
M 05 SC.fLO P'
(Last)
l L. f vA
(First)
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MOSScp.op AS50C.IATES ,,<<toO t..,""COl.rI
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(}O~ S~<t- -"\1'~ (105) 5~Cf. -~crt.7
TELEPHONE NUMBER: FAX NUMBER:
1"\' ^M' (M.!)
14 .1F :\1- S 8€hC.H, FL 3 ~ J 3'
(State) (Zip Code)
I L..I JA e.. 'eu..s 0 V 1M . N € T
EMAIL:
I. LOBBYIST RETAINED BY:
'p"'Ln~ H'TEL (tilrtJS k(l.;iUSE - <' c..J,...I€ It- ')
NAME OF PRINCIPAl/CLIENT:
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P/r<..t\~ H-rcL )6t..S C.Ot..(.I,..JS
BUSINESS NAME AND ADDRESS (Number and Street)
(16$) S1<<t--OSOS
TELEPHONE NUMBER:
,AVE:"
,
(City)
MIAr1J
8iAC.H, FL
(State)
>~J'fO
(Zip Code)
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: HAr6 ~ Vll.SvlA kfl.."'ujE'
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Hh,..J~ k1l~vje ... ~O'I .
(J ul..A f<~} E' - 5 () 'I .
U. SPECIFIC LOBBY ISSUE:
tE(QuE'~f TO (l.eptA-'E' ITrJ~'NSr',.;~ ~JZ../' t\'c.J,.~l/,...J6 "H111 A r-1 ~W
Issue to be lobbied (Describe in detail): STp..uerVllkL JL60 F
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
HISTC~ " r~S€ fLVA116,.4 f,1> . NO
Z.O,JI N b J,OIr 1Y> GF AbJUST'MT: 1'40
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) -Jt; '! e 00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).--.Jp " , 0 0 II
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":
DYes 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":
0: Are ou lobb in on a endin a lication for a Develo ment re ment with the Ci or
application for change of zoning map designation or change to the City's Future Land Use
t' Map?
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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 qr entity withol\t 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..
o Yes ~o: Are YOU representing a not-for-profit corporation or entity without special compensation
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or relm ursement... .' , , '- "
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V. SIGNATURE UNDER OATH:
ON OCTOBE~ 1ST OF \E~CI;I YEAR, EACH LOBBYIST SH,ALL SUBMIT TO TH,E CITY. qERK,: A .$IGI'iEf?
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 COMPEN~ATIO~ DURING THE
REPORTING PERIOD.
I do solemniy ',swear, that all of .the foregoing facts are true and correct and that I have read or am
familiar with the provisions ontained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
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LOBBYIST IDENTIFICATION:
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Form of Identification
~SOnallY known (Lobbyist)
Form of Identification
~nallY known (Principal)
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VII. SIGNATURE AND STAMP OF NOTARY:
FOR CLERK'S USE ONLY
Annual Registration fee: V] Yes [ ] No Amount Paid ~ A/ ~ MCR # ~ 11 b tJt)
Lobbyist Registration Form received and verified by: ~ / ,
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS. DC I
Date Paid
5f-a.-J ;r-
Revised 12/08/04