Barry S. Klein/Barry Kleina ~ .`-.^
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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.
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NAME OF LOBBYIST: (Last) (First) (M,Ij
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B1.15iIVESS NAME AND ADDRESS (Number and Street) (City) L (S ate) (Zip Code)
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.TELEPHONE NUMBER: FAX NUMBER: EMAIL.
1. LOBBYIST RETAINED BY:
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BUSINESS NAME ANp ADDRESS
(City) (State)
(Optional) EMAIL:
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out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)j
• 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:
tLSPECIFIC LOBBY ISSUE: ~~v~,~ `~-~ Sts~u)~ ~~~
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Issue to be lobbied (Describe in detail):
111. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(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 T~0 City Code Section 2-
48Z(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 ,motfrths preceding the
commencement of service of City personnel to be lobbied.) . ~ `°~ . ;,N
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A Full game of Individual Title B) Any Financial, Familial or Prof `signal Rel titihship
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RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required} ~( ,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required)...
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2188 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
present or pending 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":
application for change of zoning map designation or change to the Citv'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 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.
/ ~ reimbursement. .
V. /SIGNATURE UNDER OATH:
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A'
5 nat ~e of Lobbyist
I do solemnly swear that all of the foregoing facts are tru and ect and that 1 have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach ity Code and all reporting requirements.
Signature of Lobbyist:
Signature of P
VI. LOB ST IDENTIFICA#ION: 11 `` PRINCIPAL ID NTI (CATION:
L`~ Produced ID
Q•,5~~~1yyg4~, Form of Identification Form of I t~
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~°~o~p~~ Ily known (Lobbyist) ^ Personally known (Princip ~~
~~ ~ IGNATURE AND STAMP OF NOTARY:
'Mate of Florida, County of Miami-Dade
Sworn to and,~ubscribed before rrae
This , 3rrX day of ~~~008
Signature of Public Notary ~State~'of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dad
Sworn a~nd~subscribed bemire me
This -~`~~day of'2008
Signature of Public Notary
Notarization of Principal's
TO BE COMPLETED BY CITY CLERK'S STAFF ONL
Annual Registration fee: [ Yes [ ] No Amount Paid $ J ~~ MCR #
Lobbyist Registration Farm received and verified by:
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Paid
Revised 03/27/2008
+ 4 }~ a '~5. ~ Y ~ 9w.>. ,W
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeochfl.gov
Tel: 305.673.741 1 ,fax: 305.673.7254
LOBBYIST NAME: ~ ~~ ~ tN
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
Miarrri-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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
r~s~visacl o2;oa;2oos
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