Anthony Leon - Carrillo Pigna trA . . , . ._.,, ,.
., . ,'. i6z1 i d /
a,"-
. . , ,
0,-
..,...4
, , , .. . ,.%
City of Miami' Office of the City Clerk
#14
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 Ordinance 2004 -3435. `/
i & ij vY k
NAME OF LOBBYIST: (Last) (First), (M.I)
•
ijoo gi:ccicfive' ga .. 0 f 3 . 3 /47
BUSINESS NAME AND AD ESS (Number and Street) (City) (State) (Zip Code
30,5 3J9 MA 1�6 /sou )67- -
TELEPHONE NUMBER: :�
FAX NUMBER: EMAIL.
Please notify this office if your contact information changes address, phone, or a -mall address.
I. LOBBYIST RETAIN BY:
&,,dile) n N . 4 id
NAME OF PRINCIPA C LIENT: t ri 16
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
•
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II SPECIFIC'LOBBY4ISSUE
dpi Z&9cX g ‘42/ 1 k /Aid He.. ri33/f� /
Issue to be lobbied (Describe in detail):
Hi. 'CI AGENCI /I ° T O ` BE D A Pursuant to City Code Section 2- 482(g) include
a statement of t extent of any business, a 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)A =from 12, months preceding said City
personnel' commencement of service with the City to the present- date ; the goneral nature. of the subject
Contractual relation. '
A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship
' ofAlArg iebAlr: /1/0 ilE
331 . 4 .1083-1 0 A 113
I Q :6 )1 Vi 1 .01
1 , ate 0 Z
/ ,
•
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) #/2 „ f 5 ;5 -OO
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): / /oOiei , / � ( 156
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 fitclo: 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 t Prohibited Campaign .Contributions By Lobbyists On
Real Estate Development Issues ":
❑ Yes L/J •Nth' Are you lobbying'on a pending application for a Develo p ment A greement with the C ity o r T
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 L•7 No: Are you re resentl i a not -for- i
p q profit•corporation or entity without special compensation or
reimbursement. . . • . - •
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 PRECEDI , G CAL NDAR YEAR. STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES • - CO E SATION ING THE REPORTING
PERIOD.
1
Signatt fe .f Lobbyist
I do solemnly swear that all o he for oing fact -r= true a • correct and that I have read or am familiar with the
provisions contained in Secti• f 2 ;• of the Mia i B= =ch City Code and all reporting requirements.
F V
Signature of L L / • '
CY---‘\-
,
Signature of Principal /Clie t:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID e6-60.000 Z3O iii Produced ID p283 «./ 6 344 0
Form of Identification Form of Identification
R Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Mian -�1Lr S10, . • • ida, County of Miami -Dade
Sworn to and subscribed befo n . ,<E,.. JOHN WY/arrn and -ubscribed befo e me
This 0 day of : *. . 01 MY COMMISSION #149 "f%,! • ay of , o. , 2010
� �� +�, EXPIRES November 08 20 I
... ..4 4 :..s f / b!i ll ry 5+ -u1.nu f, I
• n : ure of • ':1t'r o a St Floridallota servi - -• _ - [ Pub is No -
ry — State of Florida
ry —
No • rization of � • bbvist's sign re Notarizati .n of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY f
Annual Registration fee: [ Yes [ ] No Amount Paid $ : .SQ K' MCR# AP. 0 . Date Paid
Lobbyist Registration Form received and verified by: + I allillIQi
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form 2010.doc P%I �1 a Revised 05/05/2010
0
„ .
jam _
J
' (CA ;
MIAMBEACH
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
LOBBYIST IvBAME. /9/f/ 46.° '
I understand that no later than February 28th of each year, I must file the
following form, pursuant to Section 2 -485 of the Miami Beach City Code, with the
City Clerk's Office for all active lobbying issues.
1) Lobbyist Expenditure and Compensation 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.
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.
.6
/ /'& / O
Signature: Date:
Revised 09/24/2010 - REP
F: \CLEF', \LOBBYIST \Expenditure S: Disclosure Form Itr.doc
We are committed to providing excellent public service and safety to oll who live, work, and ploy in our vibrant, tropical, historic
community.