Wayne M. Pathman - Marion Mathes s kc
vsilw MIAMJBEACH
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 foreseeabfy 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
Pathman Wayne M.
NAME OF LOBBYIST: (Last) (First) (M.I)
Pathman Lewis, LLP 2 So. Biscayne Blvd., Suite 2400, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
395 379 -2425 305 - 379 -2420
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
.Plearsa: rre#1fk;ill s'+d> 'ce4ifYOur.:coi tea *lrjifornial oil vl#anges ; : ;addressa� " r *gnat l s.
`�tdrie o .�ddl�e . � s
LOBBYIST RETAINED BY:
Marion Mathes
NAME OF PRINCIPAL/CLIENT:
BMG Money, Inc. 1221 Brickell Avenue, Suite 1000, Miami, FL 33131
BUSIsVEgs tiglE O ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) marl EMAIL: .n (Opttiio abmgm com
Fill out thls section if principal is a Corporation, Partnership or Trust (Section 2.482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Marion Mathes, CEO
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST,IN SUCH CORD RATIO •
PARTNERSHIP OR TRUST: got 0 6,L �D( c/ �44
� r.s IS Oda. (erazi
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ii.SPBCIFiC'LCBBY"'IS UO:
Employee Benefit - Loans at Work
Issue to be lobbied (Describe in detail):
III. CITY AGEN.CIES/INDJvJDU .LS TO .BE LOBBIED:
Pursuant to C Code Section 2
�y 2-482(a)(4) Include the commissioner or personnel sought to be cobbled, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
comm encement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2.482(aX4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
City Manager and Commissioners
x
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professlona
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who I -
sought to be lobbied as Identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship _
None
- ., u
, )4,143 73 At 3
flV 11111
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) $450 /hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $450 /hour
(Required).
The following Information must be answered:
1) Pursuant to Miami Beach City Code Section 2 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
■ , .
award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues':
❑ Yes El 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 2.181 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 a 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 C CLERK A SIGNED STATEMENT UNDER
• _TH LISTING LOBBYIN _ XPENDITURES AS WELL AS CO - . - • L ; D k HE CITY OF MIAMI BEACH FOR
THE PRECEDINQ CALENDAR Y_ EAR, A STATEMENT SMALL BE FILED EVE i THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of byl -
1 do solemnly swear that all of .regoing facts,-. r ue and rrect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beac i�j . • • T : I - - . •.-• . t- meets.
l Signature of Lobbyist: ' ,/
Signature of PrincipaUClient 117F7i / ,
VI. LOBBYIST IDENTIFICATION: 1 G . PRIN AL IDENTIFICATION:
❑ Produced ID Produced ID L_4 H326 -s ' - 60
Form of Identification Form of Identification
Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Swam tg and subscribe • before me Sworn,- d subscribed —fore me
Thi /lo day of J1 ., 2011 This :. .:.. , 2011
114 or/ . / / •
/
rMilip
� gnature of Public Notary -State of Florida ignature of Public Notary I rv, . r id . -,f; AOTA RY PUBLIC
Notarization of Lobbyist's signature Notarization of - N, 1. al', : : E ` Iwo j . STATE OF FLORIDA
STAFF TO BE COMPLETED BY CITY F ONLY �•
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" " ", SANDRA L SCIDMORE
a ' % MY COMMISSION # EE 115566
�� . * EXPIRES: July 26, 2015
' Bonded Thru Notary Public Underwriters