Suzanne A. Dockerty/Rev. John Favalora~~~~~~~
~~~`~ ~~~ P~ 5:51
g0~8FEB 26
City of Miami Beach Office of the City Cler~~;~~• ; ~~ ~ 1CF
1700 Convention Center Drive, Miami Beach, FL~$13Y39
LOBBYIST REGISTRATION FORM
Lobbyist means ail persons employed or retained, whether paid or not, by a princpal who seeks to enarurage the passage, defeat
or modification of any ordinance, resolutlon; action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any City board or committee; or any action, decsion or recommendatton of any dty personnel during the time
period of the entire decision-making process on such action, de65ion or recommendation that foreseeably will be heard or reviewed
by the dty armmission, or a city board or committee. The term speclfip0y includes the principal as well as any employee engaged
in lobbying activities. The term °Lobbyists° has specific exclusions. Please refer to OMinance 2b04-3435.
Doekerty Suzanne A
NAME OF LOBBYIST: (Last) (First) (M.I)
J. Patrick Fo.tzQerald & Associates. P.A. 11.0 lrlerr-rck Wav 3-B Coral Gables, 33134
BUSINESS NAME AL4D ADDRESS (Number and Street) (City( (State( (Zip Cnde)
305-443-9I62 3n5-443-Fih13 SAT)(dTPFTT7i nr.i r'n~,r
TELEPHONE NUMBER: FAX NUMBER: EMAIL;
I. LOBBYIST RETAINED BY:
The Most Reverend John C. Favalora, as Archbishop of the Archdiocese of Miami,
NAME OF PRINCIPAL/CLIENT: his successors in o ce, a corporation so e. for St. Patrick
s
Catholic Church and School
9401 Ri sr~a~n~P Rlvd _ _ Miami 41,nrac~ RT '~31 3R
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Z~p Code)
3n5-7E,~-ln4n 4n5-75R-59h1
TELEPHONE NUMBER: FAX NUMBER: (Optional} EMAIL: (Optional)
X11 out this s~dtion if prindpal is a Corporation, Partnership or Trust [Section 2-483 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°lo OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
_ _
Site Plan Modification Application for new pre-school building.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividualjTitle B) Any Financial, Familial or Professional Relationship
Planning Dept/Board None
Design Review Board I
None f
Board of Adjustment I None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
fLAT RATE OR OTHERj.
A} LOBBYIST DISCLOSURE: (Required) ~,~~~,
B) PRINCIPAL'S DISCLOSURE (OF L068YIST COMPENSATION}: (Required). Hen r 1 ~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-468 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Q Yes C filo• Are you lobbvina on a present or o ndina bid for goods eauiument or services or on a
nresen~Qr oendino award for goods eautom nt or service?
2) Pursuant to Miami Beach City Code Z-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Oyes ^ No• Are you lobbvina on a pending aoalication for a Development Agreement with the City or
~lphcat~on 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-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 you representing anot-for-profit corporation or entit; without special comoen~~*ion
or reimbursement. .
Y. 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
RECENED, 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. ~-----~
L S~gna~t+re of Lobby`fs'
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained i- ~n 2-482 of the Miami Beach- City Code and all reporting
requirements.
Signature of Lob
Signature of Principal/Gient: ~ ~l,v._. U ~
Si ~ YL L~3BBYIST LDEN:iFZCA3'ZON: PRINCIPAL IDENTIFICATION:
~ ° 3
g
- Produced ID . Produced ID
ci Form of Identification Form of Identification
'
~~~
~ ! Personally known (Lobbyist) Personally known (Principal)
~ ,~; VII. SIGNATURE AND STAMP Of NOTARY:
",.,
a~N NOTARY PUBLIC-STATE OF FLORIDA
State of Florid , unty of Miami-Dade State of Florida, County of Miami-Dad
~ ~
z, Sworn to ands bs i before me Sworn a d subscrib before me
an
This d Jan
ZO 08 Thi
08 Ethel Marinelli
C
~~ .
s day of
_, 20 ommission #DD421064
Expires: JANE 05, 2009
Signature of ry -State of Florida Signature of Publi Notary -State of Florida Atlantic Bonding Co., Inc.
Notarization of Lob yisYs signature Notarization of Principal's signature
FOR CLER 'S US ONLY ~
Annual Registration fee: [ ]Yes [ J No Amount Paid MCR # Date Paid ~ E
~ ~ i
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc w /~~~ )'7. D ;i aA~~~,r i mains