Franklin D. Kreutzer/General Hauling Service, Inc.m MIAMIBEACH
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 a ivities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) •2 (First) r- l~•1J
BU NESS N M ND ADDRESS (Nu er an Street) (City) (State) (Zip Code)
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LEPHONE MBER: FAX MBER: EMAIL:
I. LOBBYIST RETAINED BY: ~.~
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NAME OF PRINCIPAL/CLIENT:
B~IfrINES NAME AND ADDRESS (Number an Street) (Gty) (State) (Zp Code)
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~€LEPHO NUMBER: F NUMBER: (Optional) EMA L: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482
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.:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbi (Describe in d il): '
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
e of individual/Title
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A) Full Na B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERt (~
A) LOBBYIST DISCLOSURE: (Required) ~" ~~°~ l~ ~ ~'V ~j (~ ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP NSATION): (Required). ~~~ Iy '~ `~ 1 `~~ '"`"`F~c.
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":
~ aresent or Dendina 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 chan4e of zoning maD desi4nation or chan4e to the City's Future Land Use
Maa?
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 entity without saecial compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
-! ~ _ _
ON OCTOBER 1~ F EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STA NDER 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 OR COMPENSATION DURING THE
REPORTING PERIOD. ~--~ ~'1 , /~ n
Signature of Lobbyist
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 in Section 2-482 of the Miami Beach ity Code and all reporting
requirements. ~
Signature of Lobbyist: ~ ~ • ~' '~"~-''
Signature of Principal/Client: ~Y 3G.-. ~~s.l., S;~"t' ~( ^ ~~
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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~ roduced ID ~ [~~roduced ID ~ c
Form of Ide i ica ion Form of Identification
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~7 Personally known (Lobbyist) tWV ° r ~ n Personally known (Principal) ~ R
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VII. SIGNATURE AND STAMP O ~ vO w
State of Florida, County of Miami-Dade ~ ~ ~ Z State of Florida, County of Miami-Dade ~ o x
Sworn to and ubscribed efor me w o x ~ Sworn and~s~scrib beff~re me ~
This~day pf/T, 20 Y W ~ This ~~"'~ay of ~~~~ r , 20~
/ ~ m /~ J j ,~~ .~d•,
ablic Notary -
of Lobbyist's
Signature of Pub'
Notarization o Principal's
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ~ No Amount Paid fr _- MCR # Date Paid = Z" ~
Lobbyist Registration Form received and verified by: ,
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~y.2~ ~ ~,~LX~~~ Revised 12/08/04.
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City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tei: 305.673.741 1 ,fax: 305.673.7254
LOBBYIST NAME:
CityClerk@miam i beachfl.gov
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I understand that no later thon October 1st of each Xear, 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 addition, once an issue I have registered to lobby on has been resolved, 1 am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: te:
Ravisaci 0?_l0.7r2008