Clark David Mortonm MIAMIBEACH
.s
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the passage, defeat or modlfieatlon of
any ordinance, resolution, action or der~km of any omnmisskmer, any action, decision, reoornmendatbn of ftre City Manager or arty city board or
committee; or any adton, dedsbn or recommendation of any cfty personnel during the tlme period of the entire dedsbn-making process on such
action, dedsbn or recommendatlon that toreseeaby will be heard or reviewed by the ctlY commission, or a dty board or committee. The tens
spedfk:ally Includes Ore pdrrcipal as well as any employee engaged !n lobbying activtiles. The term "Lobbyists" has specMic exclusions. Please
refer to Ordinance 20043435.
Morton Clark Datci.d.
NAME OF LOBBYIST: (last) (First) (M.I)
C. David Morton & Associates 4444 SW 71 Street (#103) Mi.am.i., FL 33155
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-753-1798 305-740-0728 cdmorton@be11south,net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
'.Jukka Ahtoki.vi.
4431 Alton Road Miami .Beach, Florida 33140 '
I. LOBBYIST RETAINED BY:
Constance Rachel Coopersmith Residence Trust (Jukka Ahtokrnr~i.,.Atborney-i.n-Fact)
NAME OF PRINCIPAUCLIENT•
t3U,tiJrl>r5~,(yE1dtE~tp ADDRE55 (Number and Street) (City) (fate (Zip Code)
..Si(UJ~S ~Ljl ~b~~;;jj~l juk am~i@gmai.l.com.
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal Is a Corporetlon, Partnership or Trust [Section 2-482 (e)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Bret D. Orlo~e, Esq., TRUSTEE
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: COnStanCe Rachel COOperSml.th
u.S~'~' ~~~ ~,~BYi~E' Historic Designation, Certi.fi.cate of Appropriateness
and Ad uelorum Tax Status , ~~ ~ Q~ ~ L ~ J ~ ~Zo~,~P)
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
to be bbbied
V~
'~~MI~., ,C~~N~~~~N,,IY/IDUALS { :0~~'E~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 Clty 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 An Financial, Familial or Professional Relationshl
A / ' ~ b~ ~ ~ l~o'~ c
I 'Tom Ic opR D
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ 150.OO~h0U1".
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Reeuiredl. ~ 1 1 l 7 u J
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 pendina bid for aoods, eauipment or services or on a
present or pendina award for aoods. equipment 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 pendina application for a Development Agreement with the City or
application for chance of zoning map designation or chance 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
"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 anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: J ~ ~~j--
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI ATI PRINCIPAL IDENTIFICATION:
® Produced IDFDL (M6 04422120) ,produced ID ~_3a.1 - `i,3S-S~-l&~~-U
Form of Identification Form of Identification g
8 ~
~w"
~ ~~ ^ P Ily known (Lobbyist) ^ Personally known {Principal) ~S ~~
VII. SIGNATURE AND STAMP OF NOTARY:
~ ~ ~~
~ State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me ~
This ay o , 2009 This day of , 2009
~,
~.
;z-~-~..:~-r Sig ature of Public Notary -State of Florida Signature of Public Notary -State of Florida ~f
Notarization of Lobbyist's signature Notarization of Principal's signature •~!
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
:Annual RegiStratiortfee: ~( Yes;[: ] No 'Amount Paid$ ~- CR•# :Date Paid
Lobbyist Registration Form received and verified by:
F:\GLER\$ALL\aFORMS\LOBBYIST-FORMS\LObbyist Registration Form 211tl9. c ReVised:02/11/2009 q~
d
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 2-482 of the Miami Beach City Code and all repo ' requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CilyClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: Clark David Morton, AIA~ Architect
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 J 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.
l 10 DEC 2009
Signature: Date:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.dac