Andrew Dickman/Willie Floyd (2)
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~ MIAMIBEACH
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City of Miami Beach OfFce of the City Clerk
17UO Convention Center Drive, Miami Beach, FL 33139
LUY3BY15T REGISTRATION FORM
Lobbyist mtans all persons emplgyed qr retained, whether p8id or not, try a principal whq seeks to encourage the passage, tlefeat
or mgdifit:aLon of any grdlnante, resolution, action qr decision of arty cvmmissloner; any action, de[ision, remrnmer+d0tion of the
Clty Manager Or any city board pr Committee; or arty BCtlon, de[ision or recvrnmendation of any dty personnel during the time
period of the entlre deCiSyvrt•making procrss qn such adivn, dedslan qr reCgmRtiel7dation [hat f4reseeabfy wIA be heard or reyi~d
by the dty CGmmissian, or a aty board 4r Committee. The term Specifically Includes the pnndpal as well as any employe engag®7
~n bbtaying adiviues. Thee td'Ta "Lobbyists' has specific exdusian6, IPltas+e refer to Qrdinanw 200-9~3$.
,NAME bF LOB8YI5T: (Last) {HrSt) (M.I)
~''~' UC-'/~ -~- ~ ~ 3C1 l ~ Iii C.. 1 t° ` f- ~ J `+ 1 (~ }"
BUSYNESS NAME AND ApbRESS (Number and Street) (City) 5~~
J - ~ • f ( ) (tip Code)
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L L088YIST RETAINED BY:
r/~,1 ~ 1 P. F- ~ ~~l C~
NAME OF PRINCIPAtyCLiENT: ~ --~~
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (?Jp Code)
NAME OF CHIEF OFFICER, PARTTIER, OR BENEFICIARY;
• IDENI7FY ALL. PERSONS,NOLi1ING, DIRECTLY pR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN SUCH
CORPO1ZgTION, PARi'IVERSHIP OR TRUST:
fa- SPEC.TFrrIC Lyy0}~8BY LIE; i /~ 1
l..Jl~ir(~ fir!' H~=.,• L•, ~..~ r^~ P '~"~" ~ ~,~.~t'r 1 1-i (_~ i~ C~~.~~ 1 1L ry
..~ ~~. vc tivc~icv (i+s"sviue in de4yH): •~^
Y>a. Cm AGEPICIES/INpIYID{IALS 7o aE LOBBIED:
. rf' ~-
+ e, l.~hq
A) FMII Names q! IMdiviidual/7itle B) Any Finandat, ~smipal or Prgfessional' RelaCionshiP
~
(mac a~~, ~ r~~~ ~
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TOTHL F . ~~2
~tki-1.S-~a~~ 15474 L11Y M1HM1 L~LH LLtkK JJtkl S~~ ~~r.~~r~:~~ F'.t~1/1~1
IV. pI$CL05URE O(F TERMS AND AM017N75 OF Lt)aBYIST CQMpENSAT'xON (DISCLOSE Wt1E"rHER lFPt/RLY, '°
~T/PATEO/f 0r7NERt _
~~~""~~ A) La9BY15T DISGL45lJRE' (Required) 1 ~ L)~)1~ ~ j'
. .'' ~ ~~ 8~ PRINCXPAL'S DISCLOSU0.E (OF LQ9~YLST CbMP~NSATION}: (Required}. '"
Tlhe rtollowinp In~'ormation must be artswere~d:
i) Pursuant to Miami Beach Ciry Cede Section I.4B6 l:ntitied "Prohibited Campaign Contributions lay l.obbylsts
On Pracurernent Issues": ,
2) Pursuant k0 Mtaml Beach Ciry Code 2~9~ Entitled "Prohibited Campaign Contributions BY Lobbyists On {teal
Estate Di?veiopment Issues";
3) Pursuant t4 Miami beach UtY Code 284 (h} Any person (except those exempt from the deflnktiort of
"lobbyist" as Set Forth in Section 2-481 above) who only appears as a representaLivg of a not for-profit
corporation or gltilty without special compensation or reimbursement for the appearance, whether divert, or
indirect, to express support of or opposition to any item, shall register with the clerk 8S required by t3ti5
section but, shall not be required to pay any registration Fees..
V. 51GNMURE UNDlIt LATH:
QM OCTOBER 1~ OF EAirN YEAR, EACH LOBBYIST SHALL SUBMxT TO THE CIT'Y' CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EIIPENDITURES, AS WELL AS COMI+EMSATIIOM
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SMALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING TH!
REPORTING PERIOD. ~ ~"'~
" Signature of Lobbyist
I do solemnly St+vear that all of the foregoing facts are true and correct and that I have read ar am
familiar with the provi5ipns contained in Ion 2-482 of the Miami Beach City Code and all reporting
requirements,
Signature of tobbyist: ~°`
Signature of Principal/Client:
/~~Qpa~IrIST IDENTIFICATION: 1 PRIIMCIPAL IDETITIFI/CATIQN: ~7
;;Y i~roduced ID ~'~i!("U!)Ia .!//l.!_y~t12_~ C~c~U Produced Ib t~ L J-~ (l,~ (~ r
Form of Identification Form of enUflratlg~,~
^ Personally known (Lobbyist)
VII. SYGNATURE AND STAMP OF NOTARY:
+ State Of Florida, County of Miami-Dade
Sworn to and sub5[ri 1,~ Ly pERF.7.
This day af -n~~'~ISSIOx a nn6a3aza
{ ~.~r~`.~t ~- :lone 07, 201 I
~f ' uieoauei ~noa Co.
Signature of Publk Nato
Notarization of l.olibylsit's sigiaature
' . FOR CLERK'S USE QNLY 3 r, ,, I ,.,
Annual Registration fee; [ Yes j ] Na Amoun Paid V MCR # '~V Dane Paid _S! l
Lobbyist Registration farm received and verified try: (((
4~ Personally known (Principal)
State of Florida, County of Miami-Dade Xn""po~ryP 29,' ~y~~4i„
Sworn and subSCrlbed before me ~rB,,,
This day of ~G~c ~, 2U O~ :.
i ~
Signatur~oF'Aublic Nptary f State of Flora
Notarization pf Prind s signature
P. di