Tucker W. Gibbs/Upper North Bay Road HOASHZ3 N • ~j~ Q.~°'~
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m MIAMI BEACH
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 recommendaticn 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.
NAME OF LOBBYIST: (Last) (First) - (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (tate) (Code)
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TELEPHONE NUMBER: FAX NUMBER: EM
LOBBYIST RETAINED BY:
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NAME OF PRINCIPAU NT:
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BUSINESS NAME A ADDRESS (Number and Street) (City) (State) (Zip Code)
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: NJ~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: ~/A
ILSPECiFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
ul. CITY AGENGfESlINDNIDUALS, TO BE LOBBFEQ: (Pursuant to city code section 2-482(g)
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) An Financial, Familial or Professional Relationship
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06-22-'09 15:54 FROM-41.TUCKER GIBBS,P.A. 305-448-0773 T-135 P002/003 F-987
IV. DISCLOSURE OF TERMS AND AMOUNTS Olr LOBBYIST COMPENSATION (DISCLOSE WHETHER NOURLY, FLAT
RATE OR OTHER):
A) LOS BBV~ D~U~R~~oq' Ulrod) _
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Rsquired)•
The following information must bo answered:
1) Pursuant to Miami Beech City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes No: Are you lobbvino on a present or pendintl bid for goods, eauiAment or services. or on a
present or pendlnst awa-d for Goods. eauipmant orsarvice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions ey lobbyists On
Real Estate Development Issues':
^ Yes ~No: Are you lobbvinst on a oendina application for a Development Aoreement with the Clly or
application for chanaa of zoning map dosiansfion or chanoe to the CiIV's Future Land Use
tIIhD?
3) Pursuant to Miami Beach City Gode 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" es set lorlh in Section 2481 above) who only appears as a representative of snot-for-profit
corporation or entity without spacial 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.
n Yes ~ No: Are you representinll a not•for-prom corporatl0n or anti without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
I do solemnly swszar that all of the foregoing facts are true and correct and that I have read or am familiar With the
provisions contained in Section 282 of the Miami Beach City Code and all repotting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIF,tGIXfION: PRINCIPAL IDENTIFICATION;
^ Produced ID
[] Produced ID
Form of Identification Form of Identification
^ Personally known (Lobbyist) ersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
slats of Florida, County of Miami-Dade State Of Florida, County Of Miami-Dade
Sworn to and subscribed before me Sworn a d subsc ' d before me
This day of , 2008 This day o ~~~ ~t'~' ~~~.,,,,,,,~ Re Ina Harris
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5i nature of Public Note State of Florida Slgnatur of Public Nota ~ slate of Florida ` ~~ ptpipES: SEP. 30, 2011
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Notarization of Lobbyist's si ature Notarize Ion of Principal s signature ..'~~oi ~~,.~.
Www.AaltoNNorArt>!oaa
TO BE COMPLETED BY CITY CL RK'S STAFF ONLY
Annual Rplstratlon lee:. ( 1 YN (~ ] No Amount Pald f MCR K Dab Paid, ci
Lobbylel Regietrativn Form racer~red and verlAed Qy: `'
F:(CLIR\WleYr3r\Lobbvlst RepistraNon Form 3270e.doc JL~I ~ RlVI30d 03/27/2008
Signature Lobbyist
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCL URE: Required)
~~u~ ~~zrfti>r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(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 (~No: Are you lobbvinq 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 D~ No: Are you lobbvinq 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-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 tl(I No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
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 S,ectl!io~~n "2-""482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: ~Y• d{.C~W~~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to ands fisr~~~..
This ~? _ y ,u~i®I~r~
'^~ Dennis(f;i Wheeler
Signature of Pu li
Notarization o o b i t''~
~ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 2008
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 9
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid /
lobbyist Registration Form received and verified by:
F.\CLER\LOBBYIST\LobbyisEiiegistration Form 32708.doc ~ Revised 03/27/2008
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Signature Lobbyist
m MAMIBEACH
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, voww.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: W '?1lG~~Q G/tg Qs~
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.
.xtGk~~~~ !o' 2 z.. - Ocl
Signature: Date:
F:ICLERI<.OBBYtSTILobbyist Registration Form 32708.doc