Kirk P. Paskal - Winter Music Conference IA , .
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 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
specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to dinance 2004-3435.
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NAME OF L BBYIST: A A Last) (First) (M.I) 1 , CA u p <ea/J"C
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
?S y_SG3. 9 95 459, e k ,n)6/MUi ( %c r i
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT; / I (a 0
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i SI ESS NA ' (Num• - - d St (Ci (Zip Code) AN DDRES •-• x ' 3 - .,ek State) �,��f Zi Cde) e�l��,� c •.�/ ' .-�lF .6)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Lo (i S D SSFl-Ti
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY ORJNDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORR ORAy ON, PARTNERSHIP OR TRUST:
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ii.SPECIFIC LOBBY ISSUE:
V C A i u,Qi S A 0 v ( ros , z w-.- CoaT
Issue to be lobbied (Describe in detail):
in. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2- 482(g) 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 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
personnel' commencement of service with the City to the present date, stating the general nature of the sAject
contractual relation. C"1 ca
A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationr1tip G T
CD n 1.y
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): , /
A) LOBBYIST DISCLOSURE: (Required) Sal Z f l tL i r.tx,r 10 \r {
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): S / � t ' n 2- l v 2- (90 ( 017
(Required). (( �f a l ^ '/
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 �1 No: Are you lobbying 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 `UJ No: Are you lobbying 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 a not - 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 b No: Are you representing a not - for - profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. • STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE COMPENSATION • 4 - ING THE REPORTING
PERIOD.
Signature o Lobbyist
I do solemnly swear that all of the foregoing facts are true :nd orr• • .. I have read .r am famil:r with the
provisions contained in Secti• -48 If • ami Beach ity • o• - - • - ep rting requir- ents.
Signature of Lobbyist: _sr Al
Signature of Principal /Client: _ - Its
•
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
L6 ' roduced ID P2 4 0 lo i (. " 1!d
. (oOC) 'Produced ID F OL. Q 2 5 3 5 2.25 i I' 1 LD
Form of Identification Form of Identification
❑ Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE A D".4411 ■ F NO
,_. ;I. BROWN � ,I _ " JAMES BROW 4 - , � • Notary Public, State of Florid Florida, ' =�. , e of Florid
Notary Public S tat
State of Florida, County r ; e a e Commission#DD81837 S : to of Flid County of M :
1 Comm' a
Sworn to and subscribe. • • ere me MY comm. ex r n and subscribed befor m- M ission#DD818371
This y day of N p v , . • Aug. Ug 20 2 01. is t- 1 day of tv (\t) , ; _ Y Com expires Aug. 20 2012
Signs a of Public Nota — State of Florida Signati of Public Notar State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY _Y CLERK'S STAFF • k
Annual Registration fee:" Yes [ ] No Amount Pai. .[��Y� ll` Date Paid NM 1
Lobbyist Registration Form received and verified by: A
F: \CLER \$ALL \aFORMS\LOBBYIST FORMS '\ Lobbyist Registrat, - F � ' J � Revised 05 /28/2010
, ,
1 �k d 6 $ 1 BEACH
Ifew City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines /suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: e - 4/0
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.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI -DADE COUNTY
COMMISSION 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 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.
—4111111111■ l / c /40 ?"0
Signature: Date: