Christopher Donahue - Wade Pattersonm MIAMIBEACH
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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 prindpal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or dedsion of any commissioner; any action, dedsion, recommendation of the CRy Manager or any dty board or
committee; or any action, dedsion or recommendation of any dty personnel during the time period of the entire dedsion-making process on such
action, dedsion or recommendation that foreseeably will be heard or reviewed by tha dty commission, or a aty board or committee. The term
spedfically inductee the prindpal as well as any employee engaged in lobbying activities. The term "Lobbylsts° has speciftc exclusions. Please
refer to Ordinance 2004-5435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND AD SS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this ofifice if your contact information changes: address, phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Fill out this 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:
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detaip:
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(g) lnclude
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) lnclude a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City
personnel' commencement of service with the Clty 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 Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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:ts are true and correct and that I have read or am familiar with the
ni Beach City Code and all reporting requirements.
PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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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":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
1 do solemnly swear that all of the fore
provisions contained in Section 2~l 2 01
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Signature of Lobbyist: -
Signature of Principal/Client: ~J1
~VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
I Personally known (Lobbyist)
'VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to~d subscrib d before me
This ~ (o - day~Qf ~ur4usr, 2010
of
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
Personally known (Principal)
State of Florida, C
Sworn `1'`- subsc
This ~~day of
unt Paid S ~-'
by:
of Miami-Dade
efore me
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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.
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m MIAMIBEACH
City of Midmi Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: ~hY~ i sf ~~1~ ~~~ ~,~ ~~.Q
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
CVMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE !HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING_
Signature: ate:
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