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Susan Gregory Kenpnick/Miami Children's Chorus -- ~ m ..., 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. Tomrnaney, James J NAME OF LOBBYIST: (Last) (First) TELEPHONE NUMBER: 786-355-0976 FAX NUMBER: (M.l) ~0~, Laud. Lakesm FL 33311 (State) (Zip Code) No fax edgetheatre@earthlink.net EMAIL: Tommaney Mktnq. Svcs., 2811 Somerset D~., BUSINESS NAME AND ADDRESS (Number and Street) (City) I. LOBBYIST RETAINED BY: Association, Inc. Agnes Youngblood Communiuy Concert NAME OF PRINCIPAL/CLIENT: Community Concert Association, Inc. 2333 Brickell Ave., Miami FL J3129 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-8585016 No fax youngagnes@bellsouth.net TELEPHONE NUMBER: 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: Grant Application Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Cu};tural Affairs Council none " .- :.' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) none B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), none 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 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes [J(No: Are YOU lobbyinq on a pendinq application for a Development Aqreement with the City or application for chanqe of zoninq map desiqnation or chanqe 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 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 PERIOO, ~ i'/:..- II ~gnatureofL~ 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 of the Miami Beach City Code and all reporting requirements. ~ j Signature of Lobbyist: tt' ( ~ Signature of PrinCipal/CiVet: ~ D' VI. LOBBYIST IDENTIFICATION: P~INCIPAL IDENTIFICATION: Xproduced ID~~i~.Uc.:T550-4~O~30- ~roduced IDW(t\~. t...;~-r~04~O-J.o...f)Cf~ - 0 Form of Identification 0'1,3-0 Form of Identification o Personally known (Lobbyist) D Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade FOR Annual Registration fee: [ ] Yes [ ] No Amou Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 . ture of Public Notary Notarization of Principal's signature GRAZlEllA L OFFEN MY COMMISSION # DO 424537 EXPIRES: July 10, 2009 Ie Underwrilenl / " 4 lD ,., 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, decision, recommendation of the Oty Manager or any dty board or committee; or any action, decision or recommendation of any city personnel during the time period of the entire declslon-maklng process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term specifically Includes the prlndpal as well as any employee engaged In lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. ~~P1--J\~- ~.tt---J NAME OF LOBBYIST: (Arst) ~ .0, Box l.-\O)O BUSINESS NAME AND ADDRESS (Number and S eet) =\-<t~) 'dco - 0\ -=, T . TELEPHONE NUMBER: ""5, r-L- (M.I) 33\L\0) (Zip Code) :00 . . C-A::::> n-, I. LOBBYIST RETAINED BY: \'r\'A"rn" ca\\d~\~ ao~'5 NAME OF PRINCIPAl/CUENT: \nc \533 Sr'\~~ - \.JC ~;-k d\5 ;!)lSINESS NAME AND ADDRESS (Number and Stre t) (City) (3:f5 ~;;) ~ =tL\ ~~ 305 t...,C- ;;> - -q y 0) 5 TELEPHONE NUMBER: FAX NUMBER: (Optional) e-\\ cJ4:b~ ~ 33\1.\3 (State) (Zip Cod .\~ \dl',\~~~ EMAlL: (Optional) o~s. C><2~ 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: ~641~ D~'~~~e~ (ty)J:5kJ ~\ ~fr~-A~~ dOOY1; 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 no "'^ 'Y)o v0 "" I , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ('\0-\ Af2r \\c.-+blc (~ -jt"3 ~~), Y"\cA Afp\\C.Ab\e.:. (~ ""' '3 bQo(~ 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 ~: Are YOU lobbying on a Dresent or Dending bid for goods. eguiDment or services. or on a Dresent or Dendlng award for goods. egulDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~ Are you lobbying on a Dending aDDlication for a DeyeloDment Agreement with the City or aDDllcation for change of zoning maD designation or change to the City's Future Land Use Mmll 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.. L D No: Are you reDresentlng a not-for-Droflt corDoration or entity without sDecial comDensation 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 EX.:2ENDITU ES OR CO PENSATlON DURING THE REPORTING PERIOD. . \ , Signature /' 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 containe in Sectio 2- 2 0 the Mia I Beach City Code and all reporting requirements. Signature of Lobbyist: ~~~ ;L(/bM .e-V Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ~ Produced ID F\"'. 'D ~ 'v. L,....L. Form of Identification PRINCIPAL IDENTIFICATION: ~roduced 10 Fl_ \:::>~\V. L~c... Form of Identification D Personally known (Lobbyis \":.l~~"'" T~f>>~ know l~alll~-6\ Notary Public: - -sriteo/'FlOrida SIGNATURE AND STAMP i. i MyCommllllonEaplresMay 1. 2011 \~~ :t# Commlulon . 00 652265 "~ OF ",$"" D.-...... State of Florida, County of Miaml-Da "It.",'.....- Sworn to and sUbscribe~Jbef~e me or ass rl d before me This ?, \ day of M At . ;oQ. 7 This ~day of )J.A~ 20~ 7 , ~L~ ~ ~C~ Signature of Public Notary - State of Florida Signature of Public Notary - State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TOIMIPN.AC1O '" NoIIry PuIllIc . StIle crt FIor* .1.., C_..d JulOll EIpirII"" 1. 2011 C~ ~ill'" , 00 152215 ................1IaIIIy Ala VII. FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # L --Cate Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbylst\LOBBYIST fORM OS.doc