Chris S. Middleton/The Hampton on Washington Condo Assoc.~ 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.
NAME OF LOBBYIST: (Last) (First) (M.I)
N ~.f t<L o N'~ ~ '~'• 1- • ~• o. $ ~1b222 _ ~1 ~ A M\ RE~PcG~k _ ~1. ~ l~' 1
BUSINESS NAME AND ADDR SS (Number and Street) (City) (State) (Zip Code)
~4~b • 2klo• o3tb ~io5• X95. o~°J ~ n;~t~owe, ~ear~,.~~~• hc~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
__'CHE NA+~nYTo~ o~ Nta~1~ N (~Co~J . lo~De~n~ N t/nry ~~iS obi
NAME OF PRINCIPAL/CLIENT:
Ito WA`~~~1(~TorJ AvE . M~AiM~ ~P~ ~_ FL ~~39
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
9 dc'v 305 . b ~'
TELEPHONE NUMBER: FAX NUMBER: (Optional)
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. SPECEFIC LOBBY ISSUE:
W t ~~o ~,•~ ~>E PLAc G~ ~1~ntT ~E RM t T-~ar 1 ~ O Wdts~•n~ar, ~•[~.
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
TI~o~Z ~.. N-ooaE
'~ES~LrI { #'R~rf,E hZ.orl MaN
NOriE
IIO~l.L1A~ H• GPt
l 'p
N o ~I~
. GB m
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR 07n/ERf
A) LOBBYIST DISCLOSURE: (Required) LVM~ cstJM tonl'CP•P~C ~ ~' 9 ~O
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). [.J ~,~ R ~ ~,~
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":
^ Yes 'ENO' Are you lobbving on a present or oendina bid for goods equipment or services or on a
present or pending award for goods equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~No• Are you lobbvina on a oendina application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use
Mau?
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-prot:tt
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..
^ Yes ~No: Are you representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 N~ ' 1 IIENDITURES OR C NSATION DURING THE
REPORTING PERIOD. ~ ~J /
Sigdature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and bcorrect and that I have read or am
familiar with the provisions cQn~ta"in~d in Section ~2-4,82,of ~e ~Mia~ach City Code and all reporting
requirements. j
M
Signature of Lobbyist
Signature of Principal/Client:
vI. LoBBYISr
^ Produced ID
Form of Identification
PRINCIPAL
^ Produced ID
Form of
^ Personally known (Lobbyist) Personally known (Principal" ~ '~i0"T 272940
My Comrniafion
VII. SIGNATURE AND STAMP OF NOTARY: ~is,~,d~ ExpirosDsamber07 2007
UWi1N BEAUCHAMP ~ .-.--~
State of Florida, County of Miami-Dad =-; '
Sworn to and subscrib d before me ~",, ~*. MY COMMISSION304t~lorida, County of Miami-Dade
EXPIRES: gpri~9~0103nd subscribed before me
This sz~~day 20 y ~ eaaaarntir~yPapp~ ~ day of Ot~e~lat~~ , 20~'~"
. ~_
Si nature of Pu c Notary -State of FI ida Signature i ota a of Florida
Notarization of Lobbyist's signature Notariza " ~ri al's signature
F R CLE 1 USA ONLY
Annual Registration fee: [ es [ ] No A unt P ' . MCR # ~ Date Paid
Lobbyist Registration Form received and verified by
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doE Revised 1 08/04