Michael J. McAllister (2)I I~. ~'
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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 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 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zlp Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL.
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street (City) (State) (Zlp Code)
`~DS ~~(o- 17516 SOS=`7~`7'~d~~
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: .FILN2y (r LOU pt-llJ ~ (~~eS(~~~"
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
Issue to a lobbied (Descri a in detail):
ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIEDI: 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 Title B) An Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) /_~UrL~ SD'~ ~ ~~ ~~~~~
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYaST COMPENSATION): py ~'
(Required). `IOL>~ ~5~ r y y~~' y
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 lobbvina on a present or pendina bid for goods equipment or services or on a
present or pendina award for goods eauipment 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 lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or change to the City's Future Land Use
M, ap?
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 special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~ ~,,, ~,,,, ~ ~ Personally known (Lobbyist)
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~ `~ S VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade
j o ~ v Sworn to and subscribed before me
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~ This /5 ~ day of IR~~I ~ , 2009
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o, ~ ~ ~ Signature of Public Notary -State of Florida
, Notarization of Lobbyist's signature
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TO BE COMPLETED B'
Annual Registration fee: [ ]Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by: _
F:\~LER\$Alt.\aFORMS\LQBBYZST FORMS\Lobbyist Registrat
0 Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 2009
Signature of Public Notary -State of Florida
Notarization of Principal's signature
STAFF
MCR #
Paid
Form 21109.doc
Revised 02/11/2009
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 Miarp_s•_Breaek-pity Code and all reporting requirements.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURtY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) `jDU/-Ly ~~ .~ is ~y'o~-
B) PRINCIPAL'S DISCLOSURE (OF LOBBY S~ T COMPENSATION): ~ ~'
(Required). Tl'JD~~/-LC/ ~5~ ny yOrD~ `-
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. eguipment or services. or on a
present or Dending 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 Dending aaDlication for a Development Agreement with the City or
aDDlication for change of zoning maD 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
"IobbyisY' 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 Gerk as required by this
section but, shall not be required to pay any registration fees.
^ Yes No• Are you reuresenting snot-for-profit coruoration or entity without special comaensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of PrincipaUClient:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
c rr r, ~ ~ Personally known (Lobbyist)
a~~o~
d ~ o ~ VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade
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e..3 ° Sworn to and subscribed before me
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F '~ This ~day
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~ Notarization of Lobbyist's s' nature
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x ua,a` W TO BE COMPLETED BY
Annual Registration fee: [ ]Yes [ ] No Amount Paid 3
Lobbyist Registration Form received and verified by:
F:\CLER\SALI\aFORMS\LOBBYIST FORMS\Lobbyist Registratio
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification a= :.> ~ . .
Personally known (Principal) -
i..
State of Florida, County of Miami-Dade ~ _
Swom an subscribe~be~for~ me ,
This ~~ay of -~'T-"""_. 2009 ,
Signature of Public Notary -State of Florida
Notarization of Princioal's signature ` `
i
CLERK'S STAFF ON _ ti ~`
MCR # Date Paid
Form 21109.doc
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 Miai~u'_Beeet~~ity Code and all reporting requirements.
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: t y \ ~ G~ ft L ~ • I X11 C- ~ U S Tt~
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.
Signature: Da e:
F:ICLER\LUSBYIST1L.abbyist Registration Farm 32708,dac