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Rdyon R. zmrlyon III/ Trans Florida Development Corpm MIAMI~EACH ~n~~~~^~ & 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 deasion-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 refe_ r to Ordinance 20043435. d9rr L'~~ ~ ~'7?~f~ ~ NAME OF LOBBYIST: ~ (Last) (First) (M.I) C=~.o ~i~~ PFoJccT ~n ,~ ,3y~o ~'o>n~~~-~ti~!~ ~4~ M ~i4~~~ ~~-- .~ ~i~3 BUSINESS NAME AND ADDRESS ~~s ~ ~r 2 y~ (Number and Street) (City) ~~~s ~~z~~~7 (State) (Zip Code) ~~~~, ~y~~~%~,-, ~F~./~f~/„-k~ fly ~ TELEPHONE NUMBER: FAX NUMBER: EMAIL: \~ L LOBBYIST RETAINED BY: ~ ~ ~tZ.IA,NS ~ ~.. o ~i ~ A ~ ~ ~~a ~ u-e-4 wi- l,U ~ is oz ice. {~ v i ~ i ti o NAME OF PRINCIPAUCLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) 3~S'- 3'~k-2323 ©S- R7,~- ~//v ~ (State) (Zip Code) ( ' TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if.principal is a Corporation, Partnership or Trust (Section 2482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: '~ ~~«(~-Gj ~~ ~ ~~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ` ~ ~ ~ ~~ ~ ;~ ~ p ~ ~ 4 ~~ u.SPECIFIC LOBBY ISSUE: ~ i~ 60 0/~ ~- ~~ u~'~ ~-'1 ~C~~ i7~~. 2r~r9-i /a~~~ Issue to be lobbied (Describe in detail): nl. CITY AGENCIES/INDNIDUALS TO BE LOBBIED: (Pursuant to city code section z-482(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 FuIF Name of Individual Title B) Any Financial, Familial or Professional Relationship /1~~i ~~' f~N`~ Ccl~~9~1 is:~! oivC~/t',~ /lso/~r L~ c'r ~7'r1~~G-~`7~ ~'~ >~8~s?~~u~S'T1~~~=T~ 1U~F*/~PC z5 ~zr ~~~ ~~ ~r~d Q~~Z ,~, IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~~~,~ ~sC~ ~~ ~-~ 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": YJ Yes ^ No: Are you lobbvinq on a present or pending 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 `rJ No: Are you lobbvinq on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City'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. Are you representi reimbursement. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: l ° -mow w ~ ~gnature of Principal/Client' __~/,.~~~ VI. LOBBYIST IDENTIFICATION: ~ PRINCIPAL IDENTIFICATIONy ^ Produced ID ~ Produced ID ~~~ •- O~'O • ~~ aS~ ~- v Form of Identification Form of Identification Personally known (Lobbyist) ^ Personally known (Principal) 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 f 0 Sworn nd subscrib d before me d 1~l L. , 20~ This ,day f ~('; ! 2a 1 D ICJ' TARY PUBLIC~TATE OF FIARIDA ~°'""'~• ,41iet Guevara . ~ ~pµY PU~ ~~' _ ~ lln D. Krelltz g ry --State of Florid: :~ COMMISSION #DD651761 Sign ture of Public Notary - St "~ f0 ~ ~ nature of P blic Nota ~` ~ AIRES: MAR. 18, 2011 Notarization of Lobbyist's sig ommisSlOn #DD802146otarization of Principal's signature = ~o ~°' `^ 1a...••`O' FXpII'CS: SEP. 24, 2012 ''~o,~~,;;•' www.AARONNOTAeY.com -T~B~~~~'K?IQaIGIIfGERK'S STAFF ONLY Annual Registration fee: - Yes [ ] No Amount Paid $ .7 MCR # Date Paid [~ Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIST\Lobbyist Registration-Farm 32708.doc ~ ~,~,_ ' /"~~p _ Revised 03/27/200 I do solemnly swear that all of h~~for going acts ar true and correct and that I have read or am familiar with the provisions contained in Section mi ach City Code and all reporting requirements. // ~ E ~,.~a t J ~ ~ !~ • ~ +4i=!~~ `~ City of Migmi Beach, 1700 Convention Center Drive, Miami Beach, Florida 33T39, www.miamibeachfl.gov • QITY CLERK Office ~ CilyClerk@miamibeachfl.gov ,, Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: ~`S roc sJ ~ ~l~l~L_~ ~ ,'„ :. L. understand .that no later than October 1st of each dear, f must file the following ' forms, pursuant to Section "2-485 of .the IVCiami Beach .City ..Code, with the City Clerk's ' Office for all active, lobbying issues. . i 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. `1n addition, once ari issue. I have registered to lobby on has been resolved, i am required ao imrnedia elynotify the Cit)r Clerk's Office of lobbyist withdrawal in writing. .. ~,' • Z~ ~~ Signature: Dat ; .~ ~ ' F;\GLER\LOBBYIST\t.obbyist Registration Form 32708.doc