Michael J. McAllister (3)
~ MIAMIBEACH
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ity o Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons empbyed or retained, whether paid or not, by a principal who seeks to encourege the passage, defeat or modifiption ~
any ordinance, resriutkxf, anion w decision of any commissioner, arty actbn, derision, recommendatkm of the City Manager w any city board w
committee; w any action, decision w recommendation of arty rity perwnnel during the time perbd of the entire derision-making process on such
action, derisbn w recommendation that foreseeaby wiU be heard w reviewed by fhe city commission, w e cfly board or committee. The tens
specificaly krckrdes the principal as well as arty employee engaged !n bbbying actlvities. Tha term "Lobbyists" has spseNic exclusions. PNass
rater to Ordinanu 2004.35. ~
1. LOBBYIST RETAINED BY:
CRISTOp„k~ .~C CR
.~~
Fill 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°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
ILSPEGIFIG LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2.482(y) include
a statement of the extent of any business, Rnancial, familial, professional or other relationship, giving rise to an
appearenu 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 precedtnp said City
personnels' commencement of service wRh the City to the present date, stating the g)enerol nature of the subject
contractual relation.
A
Full Name of Individual Titte B An Financial, Familial or Professional Relatlonahi
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~,~` _ ~~ SS,~~ -~~ //DU,e .ei9i(Jlf
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~
(Required).
The following information must be answered:
6
1) Pursuant to Miami Beach City Code Section 2.488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes I~ No: Are you lobbvino on a present or oendina bid for goods eauioment or services or on a
>zresent or oendino 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 ~ No• Are you lobbvino on a oendino aoolication for a Development Agreement with the City or
application for change of zoning man desisrnation or change to the Citv's Future Land Use
Man?
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 clerk as required by this
section but, shall not be required to pay any registration fees.
^ Yes ~ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of PrincipaUClient: _ r~~~,,..~_,.`~
Vi. LOBBYIST IDENTIFICATION: `•~-____~ __
^ Produced ID
Form of Ident~cation
III Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
@'Produced ID D~ °tD' ~U~_ (o/-~/,& r C~
Form of Identification
t!d' Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of a BAD
Swom to subscri before me
T d i ,2009
i nature of ry -State of Florida
Notarization of Lobbyist's sianatura
Annual Regi~ratbn fes: `~' ]Yes [ ] No Amount Paid
Lobbyist Registration Form received and wrMied by: _
9 MY COMMISSION # DD643705
State Of Florid ~unty of ii-D e'pa~ ~~~ M$Y 14,2011
SWOm a su bed befor 1 @ ~-8043~1~TARY FI. Notary DiscauaAsaoc, Co.
This f da /•)cr~~ [ anna
-State of Florida
signature
Paid
Form
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-~2 of theach City Code and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
C ityClerk@m iam ibeachfl. gov
LOBBYIST NAME: ~// ~C/'/~L ~~~`~~`r/-U 5~~
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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: Date:
F:ICLERILOBBYIST1Lobbyist Registration Farm 32708.doc