Wayne M. Pathman/Commerce Bank
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.
~~1'~l rn~n ~~ c(n ~ m .
NA~F LOBBYIST: (Last) _ (First) ~ (M.I)
BUSINESS NAME AND ADD SS (Number and Street) (City) (State) (ip Code)
1+~iC~~ ~+Pcvls , ~~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY•
~~rrYl~ ~~~ ~~~~~
NAME OF PRINCIPAL/CLIENT:
~ L~UC%' ~ I s;~m ~
BUSINESS NAME AND ADDRESS (Number and
TELEPHONE NUMBER:
FAX NUMBER:
r~~~un-1- Z~u~~f ~ U8o5~
(City) (State (Zp Code)
~~(`~~ ~-~~ -r.~' 3 ~ - • ° can ate ~ ~~,
a~~
mal) EMAIL: ( Tonal (It,~j',
Fill out this section if principal is a Corporation, Partnership or Trust
• 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 LOIsBY ISSUE:
Issue to be lobbied (Describe in
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
c~ ~ rnt~~l ~I~~ ~~
it l~
~ c~m~
> ~or~rs
..-..,...... •-.w-v I~.~Y I'11'~VV~~~i rr -voorraa~ ~.v~-~rcnawuv~~ waaa.wac wncmuc rwvnar,
FLAT RATi<OR OlHERj.
A) LOBBYLST D15CLOSURE: (Regrtirrd) ~ `~ V
8) PRIIiQPAL'S DISCLOSURE (OF L08BYIST COMPENSATION): (Ibqufrtd). v ~~ ~`--'
The following inforwtaRion must be answered:
1) Pursuart to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Proctxement Issues":
3) Pursuant to Miami Beach City Code 2-464 (h) My person (exempt tttose exempt from the deflnitbn of
"lobbyist" as set forth in Section 281 above) who only appears as a represertlatlve of anot-for-profit
corporatlon or entity without special compensation or reimbursement br the appearance, whether direct, or
Indirect, to express support of or opposition to any Item, shall reglstier with the derk as required by this
section twt, shall not be required to pay any regl5tration Bees..
^ Yea aii~Arayou raorataaniina a not-.`or-oront corsnratlon or entifir wititaui sna~i aamnarr~'ion
or riaisrtwrsamant. .
V. SIGNATURE l1NDER OATH:
requirements,
Signature of Lobbyist: , ~''
<Signature of Principal/Client:
v[. t,osBirrsT
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBih1IT TO THE CRY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITINtaES, AS tNELL AS COMPENSATION
RECEIVED, 1N THE CITY Of MIIAMI BEACH FOR THE PRECxOLNO CALENDA A STATEMENT
SHALL BE ffILED EVEN ff THERE HAVE (BEEN NO EJ(PENDI1~l OR SATION DtlRIN6 THE
REPORTING PERIOD.
Signature of lobbyist
[ do solemnly swear that all of the foregoing facts true and correct and that I have read or am
familiar with the provisions n in Se ' p~2-482 of the Miami Beach City Code and aU reporting
Produced ID
Form of Identification
Personapy known (Lobbyist)
1[II. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Fllaml-Dade
Sworr-bo and subscribed before me
This r day of
,~ ,
wnti. nua~y -
of Lobbyist's
~' FOR
Mnual Registration fee: )Yes ( ] No Arnour~
lobbyist Registration Form received and verified by:
PRt</NCZrPU aDF.nmFlunoN:
E~Praduced ID ~W ~'~' ~~5 ~--1 C~i~~
Form of [dent) cation V 1~ ` 7J~~.~,7 r~~
PersonaAy known (Principal) ""f !0 - 31- aL1Q~
State of Florida, County of Mlaml-Dade
Swom and subsc fore rrte
This ~ `~ day of 20U~
Signature of Public
Notarization of P
iLY
MCA x
- State of Florida
rf's signatrsfe
Paid
R -M l bit t3YI5T PORN OS C / Revised 12/88/04
JEAN C. MCLEOD
MY COMMISSION # DD 367805
EXPIRES: November t, 2008
Bonded Thru Notary Public Underwriters
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Cbmpeign Contributions By Lobbyists On Real
Estate Development Issues":