Neil Jacobsen - Live Nation 13,7y
(A___ AMAMI RFACH R C
City of Miami Beach Office of the City Clerk 2011 OCT 25 PM 3: 12
1700 Convention Center Drive, Miami Beach, FL 33139
CITY CLE c 6i i E
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
entire decision - making process on such action, decision or recommendation that foes eablywill be head or t re the
by the c t y
time period
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. g
Tf1c k_( tJ
NAME OF LOBBYIST: (Last)
(First) (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip �� L p Co) 33c
BUSINESS I 'T
fie)
TELEPHONE NUMBER: 9s 4053 �'EJc Acc'i3se (0)L - Iii - /1)/ Co �
FAX NUMBER: C A4
EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I• LOBBYIST RETAINED BY:
LIVE /411 - t I o/J
NAME OF PRINCIPAUCLIENT:
/JvE NATION S t o F. i 3 owMb &xi> F Lk .O F T2 33`it
BUSINESS NAME AND ADDRESS (Number and Street) (City)
C /C y '-4..-; 3c) (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:
'.SPECIFIC LOBBY ISSUE:
S b lyre( 3 fit c } 15 I 1 V A I_ ■l G C.
Issue to be lobbied (Describe in detail): ����
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or -
into any contractual relationshi personnel sought to be lobbied, and whether the lobbyist has entered
commencement of service with the city to the preen date, stating theg general natu re personnel from 12 months preceding such person's of the subject
Sec 2- 482(a)(4) Full Name of Individual and C 1 contractual relationshi • .
title of person to be lobbied Contractual Relationship (Explain) YES NO
Pursuant to City Code Section 2-482(g) Every registrant shall be required to state the extent of an b �
relationship, or other relationship giving rise to an a y usiness, financial, familial or professional
sou • ht to be lobbied as identified on the Iobb ist r - • iist�rat or orm an propriety, with any current city commissioner or city
Sec 2-482 • An Financial, Familial or Professional Relationshi • y personnel who is
N
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) /5 / ,
----& e?dat ' L/VOL-C arnie 4'46Z-77W)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered: j'
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
❑ Yes VNo: 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 X 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 1lo: 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 COMPENSA ION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILE EN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
‘\.. \
Signature of Lobbyist
I do solemnly swear that all of the f• -g.'n . facts are true and correct and that I h e ad or am familiar with the provisions contained
in Section 2 -482 of the Miami c •'ty o , e and all reporting requirements.
Signature of
Si �\ �
g Lobbyist: 1" 11
A ' 111111 04 71
Signature of Principal /Clie '!�� / - 1
VI. LOBBYIST IDENTI - , TION: PRINCIPAL IDENTIFICATION:
Produced I D [ D r t& Ot L-S /
1r" C , .".. ,Q . ( produced ID F!/a., -. , /)tS'- -f be -44 -(.
Form of Identification
Form of Identification
❑ Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of.M : MP �de evti:
�_ �� ��.e� _ � State of Florida, County of • • - : -
Sworn to a d subscribed befo m Swom and subscribed bef " "''� ELISA ROJAS
"' [ ` "" " 'i '. y ELISA ROJAS
This of r► : Li, ,'' `' °P ° �e''.
? . �.`�0 Notary Public - State of Florida This C �tHday of 4 -, `� : Notary Public - State of Florida
:' : '!, : • = My Commission Expires Sep 2 2012 = • • '•' • .
My Commission Expires Sep 2, 2012
AI . I . , :. in o, 7962
47
Si• f''�re • 'ublir` ota S e': ''':�,,
Commission # DD 796247 -�!"'' -=P••• , -. „ - Commission # DO
r ature ublic N • - n. ' ,,,,, Bonded Through National Notary Assn.
N • tarization of obb is si Bonded Through National Notary As rY — to of for • = ������` • rization of Pri ipal' signatu
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: es [ 1 No Amount Paid $ UG • s MCR 1 r [ C Date Paid .�
Lobbyist Registration Foeceived and verified by: S 3 c
s . s :i:,..ki £.. k s' )63YZS FOR S',E. L.yist:Annual Rios e'ation L ..'i' Joy
Revised 1/11/2011
, \AIAAAIREAC
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 NAME: N E i t~ it-CO t St, ki
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\\ Signature: Date: