Lee Brian Schrager - FIUm MIAMIBEACH
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City of Miami-Beach Office of the City Clerk ~~~~ ~~'~ 30 ~~ ~~ 19
1700 Convention Center- Drive, Miami Beach, FL 33~~~~.~ ~l ~ ;~ ~., i ~ .~ ~ ~ ~. ~ c,~
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employ 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, recommendatiop of the City Manager or any city board or
committee; or any action, decision r recommendation of any city personnel during the time period of the entire decision=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
spec~cally-.includes the principal as ell as any employee engaged in lobbying activities. The tergn "Lobbyists" has specific exclusions. Please
refer to-Ordinance 2004-3435.
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NAME OF LOBBYIS {'mast) (First) (M.I)
F'lpr;do~ ?.N~e/~. 'or+q~ 11~-v~,vs~~. ~ FL t
o Sw ~ t ~ oo N 1~ ~~ tr ;A»~~ b 7
BUSINESS-NAME AND ADDR SS fNumher anri ~treetl ~(`ifvl is+~+o~ ice:., r~..a„~
305 - 625- `~ 1 I x to o - b2`!' •14'42 t~t¢ SCkr ~v ot3~NQ,/rlvJl~. Gown
TELEPHONE NUMBER:- FAX NUMBER: EMAIL:
P/ease notc~jr this ;office 'f your.,coniacf information changes: address,. phone, or a-mail address:
!. LOBBYIST- RETAINE BY:
Flo ~ d ~ ~ vvto-'~'o h .. ~ K..~,~r ~~
NAME OF PRINCTPAUCLIENT:
~' ~ ~,/ S . ~ l0 0 0 +~ W t Ie~d S'~ ~~" M ~ o.,w+ 1 L 6 °t
BUSINESS NAME AND ADDR S (-Number and Street) (City) (State) -(Zip. Code)
TELEPHONE NUMBER: ~5~ b2S,~j ~' FAX NUMBER: {Optional) EMAIL: (Optionai)-
Fill out this section iii principa is a-Gorpo~ation, Partnership or Trust [Section 2-482 (c)j__
• NAME OF CHIEF OF ICER, PARTNER; OR BENEFICIARY:
• IDENTIFY ALL PERS NS #iOLDING,-DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATIO ,PARTNERSHIP OR TRUST:
n:~PEC~FIC LGBBY f SUE:
vbA~ YQ.S,QM ,ow ~ ~law-t PQ.wG~- Y' / ~J ,
1 ~ ~o t,K~b ~~'~-o vl ~- -~o
Issue to be lobbie (Describe in etail): Y
Gr•-K`~ Q.e,1d is 1
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lu. CfTY AGEN±C-IE511 ~tV1Dl~ALS TQ-BE L~,!B~1€D; Pursaant_so-pity code section 2-482(8) include
a statement of the extent o -any business, financial, famili~t, 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-statemen of any- contractual relationship -(.paid or unpaid) from 12 months preceding-said- City
personneP commencement o service with the City to the resent date, stating the general nature of the subject
contractual relation.
A Full lame opf Individual tle B) n Financial, Familial or Professional Relationship
M 1 A~-~ ~,¢,o,~l^ vl S 1'{'0 ~ ~ COKVGh'~'1~ K
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IV. DISCLOSURE OF TE MS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ~
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A) LOBBYIST DISCLOSURE: ( equired) /~~ '
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CDIUIPENSATION){
(Required).
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The~~llowing inforanation ust be answered:
1) Pursuant to Miami each City Code Section 2-488 Entitled "Pro!~ibited Campaign Contributions By Lobbyists
On Procurement Is ues":
- -~ ~
~) Pursuant to -Miami- each City Code 2-490 Entitled "I~rohibited Campaign Contributions By Lobbyists On
Real Estate-bevel nt Issues":
~.
^ Yes No: Ai'e you-lo bvana on ~ nendina annl.ication fer a Dp~lneimpnt On~opmant with tho !_~f-, ni
3) Pursuant- fib Miami Beach -Cite Code 2-484 (h) 'y--person (except those exempt from the definition of
"lobbyist° s set fo h in Section 2-481 above) wfio only appears as a representative of anot-for-profit
corporatio or enti withol:rt special compensation c~r 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 xhis_
section. but shall no be required to pay any registra~iorr-fees.
V.- SIGNATUR LNDER~ATH:
PERIOD.
C
CMG ~
Signatu re of Lobbyist
1 do solemn) sweaR that all
Y f the fore oin f
g g acts are true ~
nd correct and that I ave read or am familiar with the
provisions contained in Secti 2-482 of the Miami Beach Ci Code_and all re ~ g requir ments.
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Signature of Lobbyist: 6 ~
Signature of Principal/client: !/~
VI. LOBBYIS ~ IDENTI I ATION: PRINCIPAL IDENTIFICATION:
~ ~ Produced IQ ~ Produced ID
s N F
LL o
m ° "' P
k rm of Identification
~ Form ofldentification
ersonal)
nown_
N ~ ~ Y ( bb ist
Y
)
Personally-known (PrinclPal-)
~.~ ~ VII. SIGNATURE AND
~ TAMP OF NOTARY:
~~
o
~
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o. State of Florida, Co~nty of Mi mi-Dade State of Florida, County of Miami-Dade
z a ~ w Sworn to nd subscribe bef
,~
Th' day of ~ a me
2010 Sworn and subscrib d befo a me
Th' da
of
~ , y
, 2010
`
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ignature of Public Notary - tate of lorida Signature of Public Nota -State f FI 'd
ry o on a
Notarization of Lobbyist's s gnature Notarization of Principal's signature
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~ TO BE COMPLETED BY CITY LERK'S STAFF ONLY
.Annual Registration f [ ] es [ No ,Amount Paid $ 'MCR ~ - Date Paid d j
Lobbyist Registration Form re , ive and verified'by:
F:\CLER\$ALL\aFORM ,LOBBYIST FORMS~Ldbbyist Registration For 2010.doc Revised 05/05/2010
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City of Miami Beat , 1700 C vention Center Drive, Iviiami Beac ,Florida 33139, www.miamibeachfl.gov
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CIN CLERK Office CityClerk@miamib~eachfl.gov
Tel: 305.673.741-1 , F x:-305.6 .7254
-LOBBYrST N E :_ i L ~, Q. b r~ a~ ~ Alva e/
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I understaru~ th t no-~ ter than Febr_uA ~- ~=-~f each ear (must file--the Rollo in
~ w g.
form, pursuant to Se tion 2=485 of the ~Mia i Beach - City Code, with the -City Clerk's
Office for all- ~ twe to hying---issues.
~ .
1) L~obb~iist Expen iture and Compensatio -Form-
failure to file these fo ms-an-a~timely basis-will result in-my name being transmitted-to the
Miami-fade ~-ounty_ o~m.mission-on-Ethics and for-cod~wioiation evaluation. ~
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In add-ition, i i ce a~ i sue_I-have registered to bbby on"has be~e~ resolved, I am required-
to.im ediately notify e City-Cie~k's office-of-lobbyist=withdtawa) in' writing.
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Signatur ~ Da#e:
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