Eston E. Melton III (2) /4, , 1 01.4d'l.
m MIAMIBEACH
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 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.
AfebDr/ir ESTo(J E.
NAME OF LOBBYIST (Last) (First) (M.I)
6-.og,4L PRorECTS /rvc. ,3yIo tfNCfbJ,4A4VC di IAA, 3133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3�V•Qo5•2'/Oti 3o5-y/2• S'2T?- pOv.f/yA/he/-on@eoif1//1A. .tel
TELEPHONE NUMBER: FAX NUMBER: Efl
(Please notify this office if your contact information changes:address,phone, or a-mail address. -
I. LOBBYIST RETAINED BY
ME Roo se✓F7
NAME OF PRINCIPAUCLIENT
/6 it26 NC 32PP/we. /'vier/(*miff/ FL ?MO
0
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
7% 23f�• I'1 f
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 A)VA/ p o4eRA
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
II
PARTNERSHIP OR TRUST /wee' bog g/l
P SA ^ C LOBBY U
(OF Co#(L,Ar'C6' /4/ /11ER1b4/1J
Issue to be lobbied(Describe in detail):
III. '*I ..Y AZERN MINDIVICKF eLIFS TO BE LrOTBBIBD:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,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
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Cl rr MA-N 16F,2 Al v.0 Ab,1,Nf SiRA4r/OA) AaNE
ci rr ArroRNFY 4b sr4FF poly
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 2482(g)Any Financial,Familial or Professional Relationship
i331 j.:10
U
0PE
IS :6 WV hI 330 110Z
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE.(Required) ///(6 c4-'r f E
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION). / : .e
(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 0 No: 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 g 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 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 SHAL U:1∎, T TO T Ai/CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS C. - -ATION '7 CEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL :. Fl ED EV; F THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
c '
Signatur-'ofLobbyist
I do solemnly swear that all of re
oin• f.ct-' :re true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami : ' ' r ore a • all reporting requirements.
Signature of Lobbyist: r
■
Signature of Principal/Client: ,�•
- ,y
VI. LOBBYIST IDENTIFICATI . PRINCIPAL IDENTIFICATION:
r`CD (Nj
❑ Produced ID ; 8 0 Produced ID Z CO r o E
Form of Identification ' . o" d Form of Identification o
A`" W o
137Personally known(Lobbyist) o W 8 u Personally known(Principal) '2 o . a
H
41A p"' Ej LU v) co Z
O
VII. SIGNATURE AND STAMP OF NOTARY: -' to •- Z s n v
State of Florida,County of Miami-Dade x State of Florida,County of Miami-Dade co w LL
Sworn to and subscribe before me w ;� w n arNI subscribed before me w }
0 This kl) day of \-)d-C-- 2011 _ _ T day of DKF4Ig6 ,2011 M
y N
Signatu e of Public Notary State of Flori•. Signature of Public Notary State of Florida ?• , ?
Notarization of Lobbyist's signature Notarization of Principal's signature "
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY - / //
'Annual Registration fee: [ t]Yes[. ]4 No. Amount Paid$ ?' ..-0,-----MCR# 3'."3 . A' Date Paid. ,/._ - 1.
Lobbyist'Registration Form received and verified by- !-:•. - - I
4 /F, CLE R $ALL4aFORMS\LORBYT$T,O"ORMS\LobbyistAnnual Registration Form.doc ` p Revised 111/,2011.
MIAMIBEACH
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: cS�N E. /�CL�d N
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 immediate) otify the City Clerk's Office of lobbyist withdrawal in writing.
/L 0/
Signature: Date: