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Rebecca Boyce/MB Tennis Players Assoc.t ~ i~ ~~ ,~ 4 ,t. ~~,.(' 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. b ~vGe- ,~, e ~~ cG ~. NAME OF LOBBYIST: (Last) (First) (M.I) l`7I3 T P.4 /i~ 7.- o f~-Ert,~ o i ~n11'~y-e- ~ 3 ! (~~ /~iU ~.+~ ~ 1~.~~ ~L ~ 3 / 3 y BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code//) l ~ ~S ~ 6 6 -~vCl3 ~ r ~ a~-(C>° 4~c~t"f/a „t'}'cc~b, I~1 ,P TELEPHONE NUMBER: FAX NUMBER: EM IL: I. LOBBYIST RETAINED BY: r~(~t,~r ~;eu~~ Ieh.~,s ~~Gy«s ~}ss~c,`~-~,~on, ~~,~ NAME OF PRINCIPAUCLIENT: ,,~' 7'~ /yav Ine~~`d~u., tle ~ 3/o M~a•M~ (SP4c~-, fL ?31 ~q SI ESS NAME AND ADDR SS (Number and Street) (.City) (State) (Zip Code} 3oS -bvd -6135 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 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% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: n.SPECIFIC LO /BBY 1SS'UE p_`/ ~~ltwtr t:7~Gr[,In ~~.~n1`S ~~tU I~'~'~ l~l~'"'`t n Issue to be lobbied (Describe in detail): TC~n~i1 ~,n-~er- ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 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 present date, stating the general nature of the subject contractual relation. A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship ' ~~ o~~l`SS~~ner~~ Vl ©Yl~ `L,, U n o ~ ~ ~ Ci`~' ~1 ~ ~ MMl~C' ~ e ~.~.~e.__ PAS s ct ~ ~ eL ~e li'~t~b n ;iJC ~ ~x.:~- 5~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) O B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 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 ,LSI No: Are you lobbving on a present or pending bid for goods equipment or services or on a present or pendina award for aoods eauipment or service 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": application for change of zoning map designation 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 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. reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist 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 2-48 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: X Signature of Principal/Client: , VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY State of Florida, County of Miami-Dade Swor ~~a~n~d subscrib befoQre me Thi~\~~'TTday of~~~ x '2009 Sign tur(e of Public Notary - She of Florida Nota ' ation of Lobbyist's signature o~R (? D N °~ ~.~~ Wp~a r ~~~n~ ¢~~~ ~~.z v ~. iL TO BE COMPLETED BY C Annual Registration fee: [ ]Yes [ ] No Amount Paid $_ Lobbyist Registration Form received and verified by: r: f ~L~~ ;;,€.°. ta~R t.~"~r3~`$:'"s' ~i3P. a Yti7$Y~xlBt s' rd~~fS2(r'at':aS9i PRINCIPAL IDENTIFICATION: Produced ID Form of Identification personally know MARIFNEBREGIO •fi ,,,; r_ MY COMMISSION # DD 702398 EXPIRES: September 29, 2011 ~~' Badad Thru NoMry Pudic UndervrtNBrs State of Florida, Cou o iami- ade Swom and ubscribed for me This ay f 2009 '~ Sign of Public Notary -State of rida Notar' ation of Principal's signature JERK'S STAFF ONLY ~~l ` f~~~Y ~~~~~ MCR # ...- ~srrrr 6:~ c~~.d~z;:; Paid Revised 02/SY/2009 5~~ ,_ ~ ~ ~ ~ `~ f`~ ,,~ ,~+. `~' It ~ r~~`1 r' ~-. ~,.,~ ' City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, W`N`N.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: 1`~ e ~~ ~~~ Ue y ~~ 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. 6 ~~o Signature: Date: F:ICLERILOBBYiSTILobbyist Registration Form 32708.doc