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David Sepulveda/New World Symphony~ ~/1IAMIBEA~H 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 20043435. SEOUL4Fl)A ®AI/.r.8 NAME OF LOBBYIST: (Last) (First) (M.I) iYfw lt/oei,~ -Sri//~~r/Y S~f/ C.~~e/ ~a~ /y:4.~; ~1e¢~, YG 33139 3os- 6~3-3330 ~' 1. LOBBYIST RETAINED BY: /VFw G~oe~ Syr BUSINESS NAME AND ADDI 3d~ 63.E -3330 o~d''~yr ,T~e- S~/ G:~o% ~- ~.or~." ~ev~,, ~ 33/39 (Number and Street) (City) (State) (Zip Code) NUMBER: 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: il. SPECIFIC LOBBY ISSUE: Zoo p-- 0 9 ~li~~ ~E79C'~ Issue to be lobbied (Describe in detail): MAR 0 5 2008 By Time 3: oe G~~~ ~,eoG,e~ III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~~ L0~`,,3~ ~~~~/~~~~ B) PRINCIPAL'S DIS~Y LOSURE (OF LOBBYIST COMPENSATION): (Required). It///~ 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 you lobbvina on a cresent or pending bid for goods equipment or services or on a aresent or oendina 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°: 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 rearesentinst anot-for-arofit coraoration or entity without special comuensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT 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 COMPENSATION ~JRiN~a THE REPORTING PERIOD. ~ J ~ `- Signature of Lobbyist I do solemnly swear that all of the going facts are tru nd correct and that I have read or am familiar with the provisions contained in Secti -48 f the Miami~$e~iSii~y Code and all reporting requirements. Signature of Lobbyist: `~ ~~"~ '-'~-----" Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: •'';;:;,pf.,, : ~ Produced ID Form of Identification u Produced ID Form of Identification I ~i: ~ "~'•', ' • •• KI Personally known (Lobbyist) Personally known (Principal) ~ ~ _ ~ ~ ,~~ ~ VII. SIGNATURE AND STAMP OF NOTARY: ~ w z ~ 0 m ~ ~ State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Z ~ ~ ~ N - y ~ ~ z Sworn to~and subscribed before me This ~ day of l~ ~ 1~ 20Q8 Swom and subscri ed before me Th i s r `N ' day of ~~ 20Q~ a rn W ~ ~ m , ,~ ~1, f ~~ ~- , ~ ~ ~ ~ ~ ~ ~~ 1~ '~~ ~ w w -^N' v ~ " ' Gd~~Gt~'~)a~..K . L[/w~YY Signatur of Public Notary - to of Florida ~if . ~ . Signatur of Public Notary - S to of Florida ~ 'J ~ ~ $ ~Tj F Notarization of Lobbyist's signature Notarization of Principal's signature 'i' ... •. ~ ~ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ~~ ' Annual Registration fee: [ ]Yes [ ] No Amount Paid $ ©"'- . . MCR # Date Paid 3 Lobbyist Registration Form received and verified by: ~ ~ .~ Revised 02/04/2008 m MIAMIBEACH City of Miami Beaeh, 1700 Convention Center Drive, Miami Beach, Fbrida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CiiyClerkne miamibeachfl.gov LOBBYIST NAME: DAusfl ~~pU~VED/~) I understand that no later than October 1st of each year, 1 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. 1) Lobbyisf 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 1 have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. _. ~-~ nature: Revised 02!0412008 APae~c °Zi, ~n8 Date: r~~,C"'T.~.R`.t,flliii5'15T',Ts~p.ndirure sic: i3ictttsurc 1•orm ltr.dnc