Hector Castro/Christopher Innes
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",.,.;i.cg',i;}MIAMI BEAC H
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J~kfJY~;'/.,.' City of Miami Beach Office of the City Clerk
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LOBBYIST REGISTRATION FORM
lobbylsllneahs aU persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or mddlfldi~dH of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
alii Mahaget or any city board or committee; or any action, decision or recommendation of any city personnel during the time
~eHod bf the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by ~M t:iWffj/fjrhlsslon, or a City board or committee. The term specifically Indudes the principal as welt as any employee engaged
In lobbying lldlvlties. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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; NAME O~ lOBBYIST: (Last) K.:5t)
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;j.,~~I~~~l~~E AND AD ESS (Number and Street) (City)
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0.1 TELEPHONE NUMBER: FAX NUMBER:
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: ij 'Lt~,\1t.i1.~t?BBYIst RETAINED BY:
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. NAME OF PRINCIPAJ~~:
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,. BUSINESS NAME AND ADDRESS (Number and Street)
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TELEPHONE NUMBER:
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(City)
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(State)
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(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
FIll ouHhls section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
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idK.' t-ffiNAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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. iDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A SOlo OR MORE OWNERSHIP INTEREST IN SUCH
. , ;~RPORATION, pARTNERSHIP OR TRUST:
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.:'! Uj)i;~SI'~CIFIt lOBBY ISSUE:
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! IsstJe to ~e bbl (Describe In detail):
"1 bL ,\i"~ AGENCIES/INDIVIDUALS TO BE LOBBIED:
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I Aj hlll~~ttt. bt individual/Title
B) Any Financial, Familial or Professional Relationship
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,\1'"::' r~ ':i" ~ .w. 'i';;b~SclbSURE OF TERMS AND AMoUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
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;~r:tri~A/ ' . ' ~)i lOBBYt~ bisCLOSURE: (Required)
i.f~n:r... , ' ~) pRiNcipAL's DISCLOSURE (OF LOBBYIST COMPEN
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r;;~I~'J.':!~;': ' th~ tolloWh'lg Infotmatlon must be answered:
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k~ft:,.,\", 'i b ~u~SUant to Miami Beach City Code Section 2-488 Entitled "Prohibited Cam aign Contributions By Lobbyists
~)~J::;.,;, ", I 'Oli Procurement Issues";
~W~> , . .'eJ NJ I Are 'oli lobb In on a resent or endln bid for oods e ul ment or services or oh a
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f~~;1~.~i~~."..,"" '"'1''' "',.i,' !!I.:'li.~.}l't. ; Dresent or iJendlnQ award for Qoods, equipment or service?
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~~;P~F': " i)~\ ~;!J)ut:suant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
~'A~:j':\l';' !' "Eshite Development Issues";
..{ill}l';~(" bVes'~~I" Are y~U lobbvlna on a pendlna application for a Development Aareement with the City ot
'.' ti;f{>'.:',~T~\i':;,i'::j~~r; ~ =catlon for chanae of zonlna map deslQnatlon or chanae to the City's Futute land Use
,,~,'r'~i:~' ~:~)+;~~; P~~!;Uant to Miami Beach City Co~e, 2-484 (h) Any person (except those exempt from the definition bf
f~1;!tJ;i\\r,;.':I,' I t IIlobbYist" as set forth In Section 2-481 above) who only appears as a representative of a not-for-proflt
!~l~~,~\;t:' ,j.,~ .......M ~tP?ratlon or ~ntity without special compensation or reimbursement for the appearance, Whe~her dlred, ot
"""J~: :", .', Inalfed, to express support of or opposition to any Item, shall register with the clerk as required by this
t~,:: sectloh butt shall hot be required to pay any registration fees..
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f:.:,; ,: ': , ,: . I re oU re resentln a not-for-
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';~',:", ,'VI! . '.:-1' ~tGNAttJItE UNDER OATH:
i:~;lrJb~\'~~a.~tt in OF EACH YEAR, EAcH lOBBYIST SHALL SUBMIT TO THE CITY cLERK A SIGNEt;
,;~.\h';';fN ~ATEM!Nf" UNbER OATH, LISTING lOBBYING EXPENDITURES,AS. W LL As coMPENSATION
~"J;~,",: 'U:c!tVEli/lN tHE tm OF MIAMI BEACH FOR tHE PRECEDING CALEN R YEAR. A stATEMENT
::. ,:' .' sHALL II!; ~ilEb evEN IF THERE HAVE BEEN NO EXPENDITURES OR CO PENSATION DURING THE
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r:,:}~ t do soleltllily sWear that all of the fore Ing facts are true and cotTect a d that I have read or am
':.'~.'~'.'~:ll.,.'. ta.ttllll~f.'. WItH.,. th. e p.roViSlons contained In ectlon 2-482 of the Miami Beach Ity Code and all reporting
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1:;~:;',lJ; ~i~ha~f.~i.~~ lobbYls: , ~
,\.'::.: ;L~ ~Igtiatuf@bf Principal/Client:
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\i~,.'~:' ,', " Vii ,'.::' l6b8Yist IbENTIFIcATION:
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~(>~:, '.H'r". tj.'flrtktuted iD 0 ProdUced ID
:;;\"J<:, ,II :"J';~~;q: Form of Identification Form of Identification
"?', ':'s;. ;' ,.j ,t... ~e,~SonaIlY known (Lobbyist) ~rSOnallY known (Principal)
,.,1:\1;;i.i,:Jl b'~~'!I~bNAtUrtt! AND STAMP OF NOTARY: I ';~'.., '"
;r,,"" . .' If' k~~-~i'.;i~~'dal County of Mlaml-Da~ ~ Alejandro J Pem'IUY State of Florida, County of Miami-Dade ~ ~ Alejandro J Permuy :;. ~ '.j;~:~
1.!;~1, '1,/ ", swo~.~~ subscribed before me . . Pofr.J Commission DD25~rn and subscribed before me . ~ . Pofr.J Commission D02551~l,W:V;
;r~.I,;.'" ':'1;: r,l!l " "':'i;':,i:J:~:;!! '( 0 1. ~ c= ,..1 Expires October 02. 20tillis ~day ~y . 20~ '\'1;.1 Expires October 02. 20f'< 11~Y~'
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~i'~,:\ I: Slgnatute.'of pUblic Notary -: State of Florida Signature of Public Notary - State"of Florida I :,','.',':',',(.,i:::',"!'.:,',' i":,';,,.:
,'J"1' NotartdtJc~tt bf lobbyist's signature Notarization of Principal's signature ,
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:.> I FOR CL~
AtthuallteQl~t1on tee: ] Yes [ ] No Amo~d;
lobbyist Registration Foim received and verine :
F:\ClER\$ALl\MARIA-M\lobbylst\LOBBYIST fOR OS. doc
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PRINCIPAL IDENTIFICATION:
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