Eston E. Melton III.. ~ ti 5 4 ~, ~x ,~ i ~ ~ s
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM C~ P ,,,~
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Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the passage, defeat or m~ifica ' n of
any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of the City Manager or any Gty bo~r .r-
committee; or any action, derision or recommendation of any rity personnel during the time period of the entire decision-making proc6ss on SG'ch 3
action, derision or recommendation that foreseeably will be heard or reviewed by the city commission, or a rity board or committee~.~he tpt,0 -~"~
specfically indudes the prinripal as well as any employee engaged in lobbying activities. The term °Lobbyists" has specific exclusiod~, Pleaaal '..,.,...-
refer to Ordinance 20043435. -' '- ~/
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NAME OF LOBBYIST: (Last) (First) (M.I) T, t ~_r
Cho ~~ ~(~o.r~cTS AML 3Y~o Po~NC~/~nr~ ,~~~~ lit ~/~,r~ ~ 3~i
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code `
30~-90~ ty0y 3oS-Yf~2-8~~7 ~~Sfy~e/{~~~P~~~/,,;/C.nc~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
1. LOBBYIST RETAINED BY:
SFC ~ ~~ T5' ~t-~.ilRFru c~ d F l°LoR ~ b ~ ~ I.LL.
NAME OF PRINCIPAUCLIENT:
~'3 Z3 ivy /ZT" S7~~T S~IT~ ZI ~ ryry~~~oRf~F~ ~"L-. 33~~
(~ b ( ) (Ci (State) (Zip Code)
BUS~OE~ NAAA~ 0 ,A~~yss Numbei3 nOd~yfo ? 0 ro SY~
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: ~~ y~~ ~IT~~~tGGZ', PkEs/d ~~uT
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP IN~T/EREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: ~~/~ ~~/RCZ ~ C~QC ~ ~/7 ~C~P
II.SPECIFIC LOBBY ISSUE:
~nl~ o i nl ~ G~ vEn,u ~ ~ti~~~ /~~~~ i ~o~us ~F(~/tK~1N(r C/~Y .SFt~Rl17" Cav7nifc~'
Issue to be lobbied (Describe in detatl):
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(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) Any Financial, Familial or Professional Relationship
~w4~R ~~ arty co~l~r~ss/~~~~~ ~oNC
C t l`~' /Yl/AN~Cs~?t ~N~ /K~ ~AI INI /'S /vaN~
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Iy. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ f3N
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). ~ 0 N~
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 pending bid for aoods eauioment or services or on a
present or nendina award for aoods 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 lobbvina on a nendina application for a Development Agreement with the City or
apnlrcation for chance of zoning map designation or chance to the Citv's Future Land Use
MaD?
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 renresentina anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
~ r`N ~VI. LOBBYIST IDENTIFICATION:
~ N N
.~ A ~ ~ ^ Produced ID
w A a: S Form of Identification
W.Yi ~y
E., a a
Ems-. W ~° " ~ Personally known (Lobbyist)
~'~ ~'o VII. SIGNATURE AND STAMP OF NOTARY:
~ ~~~~~
r ®State of Florida, County of Miami-Dade
c ~! p Sworn to and subscribed before me
z .,h~Nr p This d f uLY , 200~~
Sign re Public Notary -State of Florida
Notarization of Lobbyist's signature
Annual Registration fee: [ ]Yes
Lobbyist Registration Form receid
TO BE COMPLETED BY
No Amount Paid ~
d and verified by:
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and su scribed before me
This L3 of UL , 200~q
Signature of Public Notary -State of Florida
Notarization of Principal's signature
Paid
Z ^ N
O Q N
W ~ o
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LL! ~ v~
z~~
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I do solemnly swear that all f t fore f~~are true and correct and that I have read or am familiar with the
provisions contained in Secti M (,Beach City Code and all reporting requirements.
m
City of Miami i3cach, 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: ~S ~~~ ~ r~~L(~N
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
2j 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 immedia tify th City Clerk's Office of lobbyist withdrawal in writing.
~ 23 0~
Signature:
Date:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc