McClintock, Robert/SMGm fJ~1=,~s116EACH
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 2004-3435. ,(~
36YIST: (Last) (Firs (M.I)
~~
MME AND ADDRESS (Number and Street) (City) (Stat) (Zip Code)
NUMBER: FAX NUMBER: EMAIL: ~'aLt 7r ~"~ +~ ~'~" '
I. LOBBYIST RETAINED BY:
S N~
NAME OF PRINCIPAL/CLIENT:
`1 o rL M 1~~~. T s i 1~~ I, l ~ ~-('~(n.L e. ~A ~ ~ I o to
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
~LtS-Sq,2- i{(00
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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:
u.SPECIFIC LOBBY ISSUE:
2F~ ato ~-o~1~oFs MI
Issue to be lobbied (Describe in detail):
nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship
et ~Y4-1~J~ a~. iti ~ '~
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ,b ,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ d
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 lobbying on a present or pendina bid for aoods, equipment or services, or on a
present or pendina award for aoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes L+J NO: Are you lobbving on a pendina application for a Development Agreement with the City or
application for chance of zoning map designation or change to the City's Future Land Use
Map?
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 snot-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 L~J No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YI
STATEMENT UNDER OATH. LIST
IN THE CITY OF MIAMI BEACH F
EVEN IF THERE HAVE BEEN NO
I do solemnly swear tha a of
provisions contained in 'o
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
are true and correct and that I have read or am familiar with the
Beach City Code and all reporting requirements.
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
Personally known (Principal)
VII. SIGNORE AND ST,QM~ NOTARY: /~ /
State of FJer+da, County o f~//1:-P#emi=B-~de State of 1=fvrtd'/7 County of Mia+~i-Bede
Sworn to and subscribe be ore me Sworn and subscribe before me
This ~ S~day of , 2008 This ~S'6'bay of , 2008
gna a of Public No ry -State of~le+'iHa- ,/g gnat of Public Not ry -State of~Ftortda"' f,%~'
otarizati of Lob ist' s' n t~~ otarization of Principal's signature
~-~-~U-I~^[-,-~'`, ~ ~_ ~ ,~I:iVl~SYLVANIA ;~,~ af' :,,;. ,._ , %-~ CAF PENNSYLVANIA
..~ Notarial Saadp BE COMPLE ED BY CITY CLERK'S STAFF ONLY 9'Jo#anal Seal
Annual R gist, g ou Paid 3 M R # ,aa~~~ueiir;e . , m ~
Lobbyist; e~F~t~'fi i
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miam ibeachfl.gov
~~~,, ~~ ~
LOBBYIST NAME: ~~~i1 C n),,-DEC
I understand that no later than October 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.
1) 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 additi ,once an sue I have registered to lobby on has been resolved, I am required
to im ~i ately notify t e City Clerk's Office of lobbyist withdrawal in writing.
4~
Signature: Date:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc