Kent Harrison Robbins/301 Ocean Drive Condo Assoc., Inc.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 lob activities. The term "Lobbyists" as specific exclusi ns. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY: A /` /I
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BUSINESS NAME AND ADDRESS
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(Number and Street) (City)
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(State) (Zp Code)
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 OF ICER, PARTNER, OR BENEFICIA
F(1Ct h ~ ~Gi,1/`G I". c..l~ l c~ i (~rG g! ~t ~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR 1TIDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECcI~FsIC~iL,OBBY I~SjSUE:
o Go~~r'h ! e(,l
Issue to be lobbied (Describe in detail): ~ ~ /~ ~ ~ ~ O GCS
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:` ~ ~~
A) Full Name of Individual/Tittle B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) ~ V
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ V/
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On P~ement Issues":
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Dresent or oendina award for goods eauioment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estat~i82G"elopment Issues":
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epolication for chance of zoning mao designation or chance to the Citv's Future Land Use
Mao?
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 anot-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
secti ut, shall not be required to pay any registration fees..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST
STATEMENT UNDER OATH, LISTING LOBBYING
RECEIVED, IN THE CITY OF MIAMI BEACH FO~'+
SHALL BE FILED EVEN IF THERE HAVE BEEN l l
REPORTING PERIOD. (ll 111
I do solemnly swear that aJY~ the~foregoir~g~fa~ts ar
familiar with the provision cAl[~ i d ip S do 482
v
~ ~ ignature of Lobbyist:
a~~~
g ignature of Principal/Client:
~ LOBBYIST IDENTIFICATION:
~ ^ Produced ID
c Form of Identification
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?,.'~",,, ~ Personally known (Lobbyist)
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`~~ I. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ,~~~~!~ day of ;~,~~_~°t,~,2pC ~~
Signature of Public Notary -`State of Florida
Notarization of Lobbyist's signature
SUBMIT TO THE CITY CLERK A SIGNED
[TURFS, A$- WELL AS E61lPENSATInN
THE
of
fiect and that I have read or am
Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribe before me
This ,/~ -~ day of 2~ /
Signature of Public Notary -State of orida
Notarization of Principal's signature
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FOR CLERK'S~~ONLY
Annual Registration fee: Yes [ ] No Amount Paid MCR # Date Paid ~~ !~
Lobbyist Registration Form received and verified by
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised