Danielle Blake - MIAMI Association of REALTORS ..jam
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City of Miami Beach Office of the City CIe Q 22 AM 9: I Convention Center Drive, Miami Beach, F
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LOBBYIST REGISTRATION FORM CITY CLERKS O F F I C E
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.
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NAME OF LOBBYIST: (Last) (First) (M.I)
NMI A550( faql ref Pi'L ? 7CG S ' )uGUJ P ✓1Gi'mcz dauk ✓nl'C j' R_
BUSINESS NAME AND ADDRESS (Number and Street) (City) tJ (State) (Zip Code) -33/k.
G;) b -7C0 Exf . 706 .� �i�l1G ►�L f
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
; Please notify this o> cs. f f y contact:informatfon c hanges° ; addr r a- »a l
1. LOBBYIST RETAINED BY:
I111P01 kcoc,r0 afi lE/9120ER&
NAME OF PRINCIPAL/CLIENT:
700 s. Rot,p,i a flh'
Poinciana Blvd. ��►f� LfC i - , FL - 6 0-(o
B,USINE$S.14AME ANDADDRESS (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 tOECIR
Snort- - fvy, g
Issue to be lobbied (Describe in detail): j --
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whetlf thelobbyi has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months precang silch person's
commencement of service with the city to the present date, stating the general nature of the subject contractual regfionship. tt I
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) S NO
title of person to be lobbied ;_, LD
(fl or U C mm)ssfon ✓
jrn of . 1ra)-lan ✓
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g) 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)
p O-1\ s^ I ( dw as b /e -
B) PRINCIPAL'S 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 ": N
❑ Yes M No: Are you lobbying on a present or pending bid for goods, equipment or services, or ofa
rn
present or pending award for goods, equipment or service? x' 23 0
rr. tV
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyist On tV
Real Estate Development Issues ":
❑ Yes �-, /� C ' �
LaY No: Are you lobbying on a pending application for a Development Agreement with the Cittnr
application for change of zoning map designation or change to the City's Future Land Use. N
M ap?
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.
Er Yes ❑ No: Are you representing a not - for - 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 PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
LA„,,e 644
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Sect n 2 -482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: K;I:a64:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCI IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of I en ification
P� .•'otaw . ^ +c State of Florida
❑ Personally known (Lobbyist) Personally known (Prin ' Tha .
i f My Commission DD706674
VII. SIGNATURE AND STAMP OF NOTARY : �h Expires 08/20/2011
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Sworn to and subscribed before me Swo n and subscribed before me
This day of , 2010 Thi.1 day`.f Li r , , 2011
Signature of Public Notary - State of Florida gnature o ' '•Iic Notary - State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature 410 � -� f
TO BE COMPLETED BY CITY.ERK'S STAFF ONLY
Annual Rag on [ Yes t No Amount Paid $ MC t "' is Laird � f /f
Lobbyist Rogtstr ion Form ra t anc# a fled by ,
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