Elizabeth Cardona/Jay Schechter~ , 1~~IlAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 `~' o
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LOBBYIST REGISTRATION FORM c-; ~ ~
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the qassag~Jefeat~
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recomme~datio~of the~
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel ~kaing ~ tim~.-
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be hepr~l orr.7fiiewec~
by the city commission, or a city board or committee. The term specifically includes the principal as well as any empl"oyee~ygage~/~
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.__ " `~,;
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NAME OF LOBBYIST: (Last) (First) (M.I)
NC-OF~ltk , Ga~• !4 -~ 4Ss A~ ~~Za~ M~~tM~ ~~ ~313z
BUSINESS NAME AND ADDRESS Number and Street
( ) (City) (State) (Zip Code)
3~'S 3~~ w82 ~6~ 3~~ 0~~2
TELEPHONE NUMBER: ~ FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
) ~}y SGN~GH7E12
NAME OF PRINCIPAL/CLIENT:
~333 J~F~~eS~ A~ M1r~Ml 8~u{ ~~ 33 -qa
BUSINESS NAME AND ADDRESS Number and Street
( ) (City) (State) (Zp Code)
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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:
S~tiS ~~ ~AM ~ ~y ~ss1 r~ca~u.- ~u,aT~ ~ A~n A~nc~~~ ~n,~.~ ,~ y~R-v/,~
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
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c~ ry ~ M~~rM~ ~A~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
~4) °LOBBYIST DISCLOSURE: (Required) .~` ~ ~~ r ,
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 6~ /
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 No• Are vou lobbvina on a present or oendina bid for aoods eauioment or services or on a
present or aendina award for aoods, e4uipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Ye ~( No• Are vou lobbvina on a ~endina a~plication for a Development Agreement with the Citv or
apnlication for chanae of zonina mau desianation or chanae to the Citv's Future Land Use
Maa?
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..
^ Yes ~No: Are vou representina a not-for-urofit cor~oration or entitv without suecial comnensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER isT 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 PERIOD. ~~ ~1
- ~3fgnature of Lobbyist
I do solemnly swear that a
familiar with the provisions
requirements.
Signature of Lobbyist:
Signature of Principal/C
VI. LOBBYIST IDENl.~ a.,„,a~,~..
i_i Produced ID
YK11Yt,lYAL lUtIV I1h1CATION:
u Produced ID
Form of Identification Form of Identification ~ o
~ Personally known (Lobbyist) ~ z
n ~ Personally known (Principal)
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VII. SIGNATURE AND STAMP OF NOTARY?~ ~
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State of Florida, County of Miami-Dade ~;~~ a~, ~State of Florida, County of Miami-Dade u o' ~
Sworn nd subscribed before me
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7~ ~~ ~~' ,,,~ Sworn and s scri ed before me
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day of I
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N ariza tion o f Lo b byi s t s signature
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/ FOR CLERK'S USE ONLY ~~~ ~/~ ~
Annual Registration fee: [ Vj'Yes [ ] No Amount Paid ~~~~ ~ MCR # ~ Date Paid ~~ ~~ L%z
Lobbyist Registration Form received and verified by: ~'_ ~ ~,j,~P{~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/O8/04
II of the foregoing facts are true and correct and that I have read or am
contained in Section 2-482 of the Miami Beach Citv Code and all rennrtinn