Celia Fonta -Siempre FlamencoMIAMIBE~C~
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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 pdndpal who seeks to encourage the passage, defeat or modificetion of
any ordinance, resolution, action or derison of any commissioner; any adan, derision, recommendation of the City Manager or arty dty board or
committee; or any acton, derision or recommendation of any dty personnel during the lime periotl of the endre derision-making process on such
action, decision or recommendation that foreseeably will be heard or reviewed by the cky commission, or a city board or committee. The tens
specifically Includes the principal as well as any employee engaged !n lobbying activities. The term "Lobbyists" has apecifle exclusions. Please
refer to Ordinance 2000.3435. ~' /~
.tCD n ~ __ C. 2~l a
3USINESS NAME AND ADDRESS
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(Last)
~_ ~/'~rd
r
11/l..///r ~ v f!'~~
~3/S
(Zip Code)
Fill out this section M principal is a Corporation, Partnership or Trust [Section 2.482 (c)j
• 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:
II,;SP.E~IFIC:xLO:B6'X~IS~,U~E'
in
pm
m 'CIT~1(3AGEWCIES/INDI171DUALS ~TiO~BE~LQBBIED: Pursuant to City Code Section 2-482(g) include
a statement of the extent of any business, flnanclal, 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.
Ci9G
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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 lobbying on a present or oendina 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 ~ No: Are you lobbvina on a oendina application for a Development Agreement with the Citv or
application for chance of zoning map designation or chance to the City's Future Land Use
Map4
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 representing snot-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 Se~tion 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: ~l-0?~-• ~ ~'"
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID~~ 1~
Form of Identficatio Ogtt11il11Gl//
,`~```~j~\PM R• Hq j
^ Personally known (Lobbyist) ~`~ ~ ; ~oMMISg/pN•.,
0 ; ~,'~ ~~oery rg Fl
VII. SIGNATURE AND STAMP OF3~•R'AR~S':v• a`~
no; ~~ a
State of Florida, County of Miami-Dade %y
Sworn to and subscribed before me ~~A~~
This ~.(o day of D,Ai-,~~m,20tl'R ~'~.~a•..____..•~
Signature of Public'fdetary=,_~fate of F
Notarization of Lobbyist's signature
~P,R/IN/CIPAL IDE,NGTIFICATION:
lJ Produced ID I ~ ~~ v' \~~~~111i1111tllllil//
~\,\AM R. yq
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Form of Identification .• ~oMMISSip
_3 * J ~~eyiaary rBaE
~~ Personally known (Principal) =zo ~ /~~o•o
Sagte of Florida, County of Miami-Dade 'ii~~~0, STATE 0 ~.~````~
~orn and subscrib afore me i~ ///IIIIIIt11N1
Yhis a ,}of ~ , 2008 .~
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Signature of Public Notary - St of orida
Notarization of Principal's signs ure N~~l~~
•-- ~ ~ .
TO BE COMPLETED BY CITY CLERK'S STAFF ONL
Annual Registration fee: j Yes'.[ .]!No AmounYP.ald:$ ~ MCR # `Paid
LobbyisfRegistratlomForm received and_veritied by:.
-F:\CLER\;ALLIaFORMSILOBBYIST FORMSILObbyist Registratioo- Form 211e9.doc Q Revised"02 11/20 9
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Signature of Lobb
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City of Miami eeoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, viww.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~e / ~ ~~'^~°`
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.
~'
Signature: Date:
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc