Yvette N. Harrish- ~ n.~.-
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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 prindpal who seeks to enoourege the passage, defeat or modification of
any ordinance, resolution, action or decision of any commissioner, any action, dedsion, recommendation of the Cily Manager or any dty board or
committee; or any action, decision or recommendation of any dty personnel during the time period of the entire dedsion-making process on such
action, dedsion or recommendation that foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term
spedfically indudes the prindpal as well as any employee engaged in lobbying activities. The term "Lobbyists" has speclflc exclusions. Please
refer to Ordinance 2004-3436.
NAME OF LOBBYIST: (Last) (First) ( (M.I) / 1
~t'i~R$-E~ 5'u6~C,"c IZFIa~°~~orv ~ , r~U Vii- r 1 la(.f`' ~~T- ] l~~Scfl'~;~s~ ~f~fz-+~ r ~L j j i t~ 1
BUSINESS(NAME AC~ND ADDRESS` (Number and Street) (C-ittyT)- (State) (Zip Code)
C~5'~~ ~ 1 ~ ~ ~~ ~Jy ~~~ 1 1 CC'~~~ ~UCS~S`-1C ~ ~-~.~Zl~3t..t~ . ~GAA
NUMBER:
EMAIL:
LOBBYIST RETAINED BY:
~cLv+.~ C i h c ~ )~n.-C_- ~ I'~ r~~ : ~,-',krzt fL~ E
NAME OF PRINCIPAL/CLIENT:
l(/ W 7 ~ ~~ ~~ '- Nrw ~c;tui 1 iV'~ iUU~
111. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code Section 2~82(g)
Include a statement of the extent of any business, financial, familial, professional or other relatlortshlp, 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.)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
FIII out this section H 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:
II.SPECIFIC LOBBY ISSUE: n
j^h~ 13~" anrt~ 14~v~e,R~cer1 g~~c.~ 'h..~„~ ~~~-~'~!~-X
to t>e
A Full Name of Individual t!e B An Financial, Familial or Professional Relatlonshl
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
V
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): O
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes L~INo: Are you lobbving on a present or Bending bid for goods. eauioment or services. or on a
present or pending award for goods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
_^ Yes L`f No: Are you lobbvina on a pending ao~lication for a Development Aan3ement with the Citv or
application for change of zoning mag designation or change to the Citv's Future Land Use
McDT
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 a not-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 Gerk as required by this
section but, shall not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH:
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 City Code and all reporting requirements.
Signature of Lobbyist:
Signature of PrincipaUClient:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 2008
Signature of Public Notary -State of Florida
Notarization of Lobbyist's sii6nature
TO BE COMPLETED BY
Annual Reglstratlon fee: [ ]Yes [ ] No Amount Pald a
Lobbyist Reglstratlon Form received and verlflad by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc
PRINCIPAL IDENTIFICATION:
Produced ID ~ `-W
Form of
^ Personally known (Principal)
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City of Miomi Bsach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CilyClerk~miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
l' V tTc 9 v = ~-ft-(t-~
LOBBYIST NAME:
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 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.
i
O 2 f G2../O~
Signature: Date:
F:IGLERILOBBYIST1Lobbyist Registration Form 32708.doc