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Nicholas Cascionem 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 activities. The term "Lobbyists" has speciflc exclusions. Please refer to OMinance 2004-3435. ~~Cj~ N ~L /~/'ic loo LA S NAME OF LO Gl-# of ~ I ~ (Last) (First ~/~s; ~ 1330 ~~ 3 BUSINESS NAME AND ADDRESS (Number and Street) (City) ads (og7_-b~ 77 30~' X37 203 L% I. LOB,tB~YIST RETAINED B C/11 ~ ~~sT AIA111n1w~~~r~w, (M.I) (State) (Zip Code) /L,~,p tad b L1c !~'q5 !t cd MAIL: ` IIiLIC1Y I . -- / 3 ~,~, N ~~ ~ ~ eT D~.9 L, ADDRESS (Nu ber and Street) (City) ~ -h17~ ~©t~ r,37~o3~ ti out this section if principal Is a Corporation, Partnership or Tru • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Zip Code) • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u.SPEC1FiC LOBBY ISSUE: Issue to be lobbied (Describe in detail): nl. GITY ~Q~EN~IES/INDIVIDUALS T,O BE LQBB[ED: Pursuant to City Code Section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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 said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A) Full Name of Individual~tle f~ f ~ t ~4M'''I ~Ssl~aly ~2 ~ L`v /~~ ~ ~ ~ ic~ar, ramlllal Or N a ,~ ~ ~a ~ ~'1 ~t ~ ~_ 1 ~ ~ IV 6 ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): w A) LOBBYIST DISCLOSURE: (Required) `3 ~ L ~-ra t 'i ,~ ~',vt ~ L rr-Lr ~` S B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 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": 'Yes ^ No• Are you lobbying 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 lobbying 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 only appears as a representative of snot-for-profft 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 representina snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client: _"'~ VI. LOBBYIST IDENTIFICATION:' O'Produced ID ` 1--~ Form bf ^ Personally known VII. SIGNATURE AND ST State of Florida, County of Miami-D~ Sworn t anfJ subscribed before me This^~~_day of b~ ~ , SYgni~ture of Public Notary -State of R Notarization of Lobbyist's signature " PRINCIPAL IDENTIFICATION: b~_(G,3 ~I ~ produced ID L~c:aSO-~Za ~ 3-/v~-d tion Form of Identi~, ~; `a M-Y ~°~ ^ Personally known (Principal" ~. ~ . „~,,, ,~ < =\ Y. , ~, ~ {, p t~ ~' m tA ~ ~~ ~ ;~~~~ ~ ~ ~\ ~~~~,`~~~`~~.~~,, State of Florida, County of Miami-Dade n ~ .. ~ ~\ a~ od ~~s ~ Sworn a d subscribed before me `w 9 ~~ ~' 2009 ~~. ~'~ o ~°>~° of ~Q ~ This da ry~?r `~ T~ , y a, U = ~ ~ ^~"' ,~=~ ~ r , , Sign ture of Public Notary -State of Flori a ~•,~°' w ~~ r Notarization of Principal's signature '?~;?~~" TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.doc Revised 02/11/2009 I do solemnly swear that all of the fore g fa s ar true and co ct and that I have read or am familiar with the provisions contained in Section 2-482 o e M~i Bch City Co rand all reporting requirements. p ' ij f ~ ~t ~ 'Y ( p ~ t ~ t~ 3 ~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: / ~~~' t~0 ~,q- S ~. ~S ~~~~ ~ i'- 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. 2 2~'' p Signature: Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.t1oc ~ y ~ ~ ~' O. ~ ~ Z C --, Q~ m ~- ~ l ~ ~~ ~ m ~ v 0 ~ ~ ..,~ rn ~ 3 Y ~1 v • rt O C Z C ff • 1 ~ ~ N O ~ -w n a cap a ~ ^ v; ~J ~~ ~~ t~ ~~ N O ~; z 0 N ~o t,.i n ~ A c~ 3 1 ~ n m _~