Miranda Reymundo/Longkey, LLCMIAMI BEACH
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, I~R9#f~-8 AM I I ~ 44
LOBBYIST REGISTRATION FORM CITY CLEKK~S OFFICE
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, anion 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 specifcally 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) (rust) ~'~~''~
l7C ~r ~ •n e< i to 4378v sw 26+" s'f. S~~e, 20~ 'FO.. `33 ~'7~
BUSINESS NAME ADDRESS (Number and Street) (City) (State) (Zip Code)
3C~-221-6®~ 305-22~-600 oceA~n36s1@~ctc~q.
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINi;IPAL/CLIETdT:
432 1'oY1C Aver` ve Sos~~i New `(of K N `(. -oOl6
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (7p Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
c~
out Mis
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a
or
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
caerc3;o ~~rvtq,~c~ez ~S..~is ~Seche
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
- 1oa 3'Z~'tS~<ee~ -~iO,ttnt ~eac~.-I.~,v~;.};on
Issue ro be lobbied (Describe in detail):
III. CIfY AGENCIES/INDIVIDUALS TO BE LOBBIED:
) Full Name of Individual/Title
A B) Any Finandal, Familial or Professional Relationship
''
11
T1~tS~0'f~C. ~teSC~lvn~(Or~ ~OCaC~
CM8 `Pta~r+' 'L~~o.c~wvc ~~.
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTNERf.
A) LOBBYIST DISCLOSURE: (Required) ~ ~ 05~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
tro
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":
C Yes ENO: Are you lobbvina on a present or oendina bid for goods, eauioment or services, or on a
present 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
Estate Development Issues":
nYPS ~ No: Are you lobbvina on a oendina application for a Development Agreement with the Ciri or
aoolication for chance of zoning map designation or chance to the Ciri's Future Land Use
Mao?
3) Pursuant to Miami Beach City Cade 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
wrporation 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 repres_~ntinp a not-for-profit corporation or entiri without special comcensation
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 C AR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE CO PENSATION DURING THE
REPORTING PERIOD.
Si~ature \ Lobbyist
I do solemnly swear that all of the
familiar with the provisions containe
requirements.
are true and correct and that I have read or am
32 of the Miami Beach City Code and all reporting
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
IDENTIFICATION:
Produced ID fDL'~M663-73o-3$-OG/-O)( Produced ID FOL-01 V22~-526.6(,'88=~
Form of Identification Form of Identification
Personally known (Lobbyist)
n Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This da~of F~i2n rt,
~fic ~ N u ublic Biale of Florida
~IlD~®r~iL-4~
Sign ure f'p ~ o i~ e f t
Notarize '
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This Zda r of/r-6/~G °~---
J go ~ ~ 'aie of Florida
C~,~,/.- 1'm~k l ~ u ~~a
[~ ~~ ^D523057
Sign tureofPublic ry S Flofx)ae.o ~~:?4fC
Notarization of Principe s stgna ure °
FOR CLERK'S USE ONLY ~,.'
Annual Registration fee: [ ]Yes [ ] No Amount Pai -"MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/06/04
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
CityC Jerk@miamibeachFl.gov
I understand that no later than Otitober 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
l) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediate n~the City Clerk's Office of lobbyist withdrawal in writing.
Signature:
Revised 02/04!2008
~P 10 8 , ZOO'H
Date: