Brittany R. Claym MIAM!BEACH
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City of Miami Beach Office of the City Clerk 2009 ~
1700 Convention Center Drive, Miami Beach, FL 33139 `U 22 P!~ 4; 51
LOBBYIST REGISTRATION FORM ~ ~ ~ ~~` 1 ~: ~ .; : • . ~ ~ .
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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 recemmendation of any city personnel during the time period of the entire decision-making process on such
action, decision or recommendation that foreseeably w1ll be heard or reviewed by the Gry 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: I (Last) (Firs) (M.q
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(3os~53~-~g2`f X505' S3S - 231`1 B~;-4~Av,v ~ MG~F~.C~r-r,
TELEPHONE NUMBER: FAX NUMBER: E IL:
1. LOBBYIST RETAINED BY:
M I avv~ l I~G.V °)' 1-Q-S~1 tiv- ~~ ~ tqn ~2,STtJ~
~2S~ NE ZKd /~ve,~-~e. ~ lob Mi0.tnn; Fl,. 33i3~'
BUSINESS NAME AND ADDRESS (Number and Street) (City) T (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(3(75 ~ ~3~~-~i5`Z~-
Fill out this section if 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:
n.SPEC.IFIC -.LOBBY 'CSSUE
~r~~-~"s ~ov ~-N~, M~av" ~ (' Av ~ Les~,t+H~ ~i 1 ~ ~e.s-h~.lo,
Issue to be lobbied (Describe in detail):
ul. CITY ~AGENC(~~/[ND.IVIDUAL'S TO :B~E;~LABtB~IED: Pursuant to City Code Section 2-482(8) 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 pn3sent date, stating the general nature of the subject
contractual relation.
.•A.. Eull.Name of Individual Title B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (D-SCLOSE WHETHER HOURLY, FLAr~
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
~+~o to
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). ® ~i,,,~ i e
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 lobbvinq on a present or pending bid for goods eguipment or services or on a
present or pendtnq 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 Lid No: Are you lobbvinq on a pending application for a Development Agreement with the City or
application for change of zoning map desianation or change to the Citv'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 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.
l~ 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`~~~
Vl. LOBBYIST IDENTIFICATION:
TION:
/Produced ID ~~ OL~k Cytx~--076 °~a'(o3~'_U~roduced ID ~G~L ~-~.' a~-SF~(a-67 -/~~ CS
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day~of ~urt1 ,, 2009
rte' ~----.4~n~ Jl ~ L.
Form of Identfication Form of Identification
t ,••;:~ei%~;,, IaRFG! ~~ATCNELL R+'~;-..,, ISABELSA1t~Ell.
^ Personall known ~ _ IJa ~~~r~'~s~~` ~ ~~879~91 ~:
y ( ~: ~ 1a,2U1a Personally known (Pri ~~)''...f tv1YCAMMISSIONttDD879A91
'~ a ~ ~. EXPIRES: April 13, 2013
~8• Bonded Th~ Notary PubNc UrMerwrllers
VII. SIGNATURE AND ~~ ~~ `R "`' ~~'°' <i7licUnderwriters a ~'
TA4~:~ __._ ______
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Signal~ire of Public Notary -State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribe before me
This ~~day of ~V~ 09
Signatu a of Public Notary -State of Florida
Notarization of Principal's signature ~/~-~~~ . Qj D~ ~
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fec;--[-Yes [ j No Amount Paid $ MCR # GN° ~ Date Paid
Lobbyist-Registration Form received and verified by: ~c-~r
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 22I09.do~- Revised 02/11/2009
rGRIVU.
5' atiu obbyist
I do solemnly swear that all of the foregoing facts are true and correct and t e read or am familiar with the
provisions contained in Section~2 of theMach City Code a~ reporting requirements.
~ MIAP~~IBEACH
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
LOBBYIST NAME: g r ~
CityClerk@miamibeachfl.gov
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.
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Signatu Date:
F:ICLERILOBBY-ST1Lobbyist Registration Form 32708.doc