Jeffrey S. Bass
,.
LL~
City of Miami Beach Office of the City Clerk Z~06 ~~~ ~ 6 PM 2~ 29
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM ~ ~ ~ ~ ~' L ~- ~~`'" ~ ~ U i' ~ ~ rJ {~
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.
~S ~lt~v eve S
NAME OF LOBBYIST: (Last) (First) (M~l)
S~~h S~ ~c~sas P P~ •, ~I~ SW 1~" S-~ ..3"d Moor. MiGlhtii, , ~L 3313a
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Ip Code)
3bS 3~1-Iteo~v (305) Sgt-Ot1451 ibA.sslC~skub~~bass.co~
cou iG nii innctFR• FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
I)~GO ~~¢ch< /AlNy ~ j'1~
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAM~D A~RE,SSS~" (Number and Street) (City) (tate) (Zlp Code)
TELEPHONE NUMBER: ~~,,~~~~''•• FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 282 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°,6 OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
~1x7~,~h'cl/1 'tl~ °K~D l~ t~ c~ t~,/l~r~ ~o0lra~e.. _--
Issue to tie I~bbied (Describe in detail): ~ U (J
ul. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(8)
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
'~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ: j /;
A) LOBBYIST DISCLOSURE: (Required) ~ / -~ ~ 1_ ra. ; a
B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTIIICfffJJdllO~~~MPENSATION)CG~
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O~n/Procurement Issues":
^ Yes LYJ No• Are you lobbvinp on a present or pending bid for goods equipment or services or on a
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":
^ Yes ~ No• Are you lobbvinp on a pending application for a Development Agreement with the City or
application for change 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 on-y 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 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
1 do solemnly swe that all of he
provisions contai din Section 4
Signature o obbG~ v
true and correc d that have read or familiar with the
amity Code and all reporting requirements.
Signature of
Signature of Princi~?1Client:'~
VI. LOBBYIST IDENTIFICATI
^ Produced ID
o~ Form of Identification
g
~ >~
!~
~
L1~ Personally known (Lobbyist)
~ rK
~ VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
~ Sworn to d subscri ed before ((fi~e~ ~
This 1~ day of [y!P~08
gnature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
0 Produced ID
Sworn. d subscr ed befo a me
This day of 2008e
~~1-~
Si nature of Public otary -State of Florida
Notarization of Principal's signature
Form of Identification
LW Personally known (Princi
~E-R WIXYYELI
AAA ~~ ~ DO Sb31g5
°"'~~~
State of Florida, County of
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes [ ] No Amount Paid ~ C # -Date Paid
Lobbyist Registration Form received and verified by: J,
6:\CLER\HATL\forms\Lobbyist Registration Form.doc Revised 03/27/2008
City of Miami Beach, 1700 Canvention Center f7rive, Miami Beach, Florida 33139, vrww.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@miami beachfl.gov
LOBBYIST NAME: ~1e~~pU " • ~~~
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 j 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.
Ina once an issue I have reg
to mmediat ly notify the City C~k s
Signature:
~I'obby on has been resolved, I am required
of lok~ist withdrawal in writing.
(~
ate:
F:tCLER1LOBBYfSTILobbyist Registration Farm 32708.dac