Neil Jacobsen - Live Nation CA M I A MEAC I BEAC '
City of Miami Beach Office of the City Clerk
• 1700 Convention Cen er 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 Ordinance 2004 -3435. —�— p /Vr
O coSsea a l (First) (M.I)
NAME OF AJcfldA S (Last) E&ba I @,d Sae / Ft. 1O i tf0 F 3-38
L,�oe N
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
C l sy— yS3 - anSo I /.1E it. 3AGoBS EA) Pboer e70. .
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact info mation changes: address, phone, or e-mail address.
1. LOBBYIST RETAINED BY:
L►I NcTedo
NAME OF PRINCIPAL/CLIENT:
LIJc JlalYan S(b E.Alc.biel �7 a &a7 /ft Pt. LcatebrAff a 3iy
BUSINE
y ys3 — ��.cn S 5 NAME AND ADDRESS (Number and Street) ( (State) (Zip Code)
TELEP ONE 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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
uSPECIFIC LOBBY ISSUE:
.Y�lto gird" 11 C.Omebt, reeTvaf I/04. Cfti iT
Issue to be lobbied (Describe in detail): J
iii. CITY AGENCIES /INDIVIDUALS` TO BE LOBBIED: Pursuant to City Code Section 2 -482(g) Include
a statement of the extent of any business, financi 1, 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 subject
contractual relation.
A) Full Name of Individual /Title B) Any 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)
B) PRINCIPALS 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 ":
❑ Yes ,No: Are vou 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 ":
0 Yes ligNo: Are vou lobbying on a pendina pplication for a Development Agreement with the Citv or
application for change of zoning ap designation or change to the Citv's Future Land Use
Map?
3) Pursuant to Miami Beach City Code , 2-4 4 (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 an registration fees.
❑ Yes No: Are you representing a not -for -p • fit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR. EACH L n BBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBB ING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR HE PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXP : NDITURES OR OMPENSATION DURING THE REPORTING
PERIOD.
' A
Signature o Lobbl
I do solemnly swear that all of the foregoing facts a e true and correct hat I have read or am familiar with the
provisions contained in Section 2-482 of the Miami : a City Code and a eporting requirements.
Signature of Lobbyist: I ` (j'
Signature of Principal /Client.' p
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Er Produced ID a Prnees Li; N Produced ID fL Yrl ✓ZeSi%Lemy2
Form of Identification orm of Identificatio
❑ Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
,ulnll/.
State of Florida, County of Miami- Dade�.�`�t ''•, State of Florida, County of Miami -Dade , S j ''�., ,�
Sworn to and subscribed before me 45. n1%.° ms 's Sworn and subscrib - d bef•re me p •� ...... •. O',
This 7 day of . .�i i ' , 2D1f,Y EEC S ; a This _14 day of . u: _rr.�' , 2010 `*f a' •
+ ExPIRES
_ EXPIRES •
• = I E E 29 XPIRE a ,
• - S .
Zt• $6 19. / , �:.• . Sap. .201 :32E
i nature of Pu r f a — St • of s S r . 2
1!•• :_�$ ` Signa •
ure of Public otary /tate of Flo ; ' �o k`g
Notarization of Lobbyist's sign ure '•.,c ��•, Notarization of Principal's signature •, :. •••••
' / / / /II. a.... , ' u C SI stow- .
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ .] Yes [ ] No Amount Paid $ -V50 'MCR# ate Paid //7 f P
Lobbyist Registration Form received and verified by: -
F:\CLER \S ALL \aFORMS\LOBBYIST FORMS \Lobbyist Registration Form 2010.doc Revised 05 /05/2010
i\A AM I BEACH
City of Miami Beach, 1700 Convention Center Drive, iami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
r
LOBBYIST NAME: ` 0 t Ql. 1 \)
I understand that no later than Februa_a 28th of each ear, I must file the following
form, pursuant to Section 2 -485 ofl the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure and Compe sation Form
Failure to file these forms on a timely b.sis will'result in my name being ,transmitted to the
Miami -Dade County Commission on Ethi s and for code violation evaluation.
In addition, once an issue I have registe ed to lobby on has been resolved, I am required
to immediately notify the City Clerk's O ice of lobbyist withdrawal in writing.
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Signature: Date:
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