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Page 1 of 5 <br /> <br /> <br /> <br /> <br />Office of the City Clerk <br />1700 Convention Center Drive <br />Miami Beach, FL 33139 <br />305.673.7411 <br /> LOBBYIST REGISTRATION FORM <br /> Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or <br />modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City <br />Manager or any City board or committee; or any action, decision or recommendation of any City personnel during the time period of the <br />entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the City <br />commission, or a City board or committee. The term specifically includes the principal as well as any employee engaged in lobbying <br />activities. The term “Lobbyists” has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3, entitled “Lobbyists,” <br />for additional information. <br /> <br />Instructions: Please complete all sections of this form and submit the completed form, with the applicable fee, to the Office of the City <br />Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular <br />section, you must write “none” or “n/a” in that section. Any change to any information originally filed, or any additional City <br />Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. <br />The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. <br />Separate registration forms shall be required for each principal represented on each specific issue. <br /> <br />I. LOBBYIST INFORMATION: <br /> <br /> <br />NAME OF LOBBYIST (Last) (First) (Middle Name) <br /> <br /> <br /> <br />LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) <br /> <br /> <br /> <br />LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS <br /> <br /> <br /> <br />II. PRINCIPAL INFORMATION: <br /> <br /> <br />NAME OF PRINCIPAL (Last) (First) (Middle Name) <br /> <br /> <br /> <br />PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) <br /> <br /> <br /> <br />PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS <br /> <br /> <br /> <br />If the principal is a Corporation, Partnership or Trust, the following information MUST be provided <br />pursuant to City Code Section 2-482(c): <br /> <br /> <br />• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY (if none, write N/A): ____________________________ <br /> <br />______________________________________________________________________________________________ <br /> <br />• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH <br /> <br />CORPORATION, PARTNERSHIP OR TRUST (if none, write N/A): _______________________________________ <br /> <br />______________________________________________________________________________________________ <br />