Dale O. Overmyer 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 pnncipal 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 dunng the time penod 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 pnncipal as well as any employee engaged in lobbying
activities The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
oVEi ►tfeg- PAU. 0
NAME OF LOBBYIST (Last) (First) (M1)
pita 0~NW. Alt-Ctitrf4f5 323 fi Std NW WAUAIN6i ■ DL 20001-
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(wi") 333 55ab (zvt) 333 55iq dale@ atAltdver"w►t.1c�r.co M
TE EPHONE NUMBER F NUMBER EMAIL
Please notify this office if your contact information changes:address,,phone, or e-mail address;
I. LOBBYIST RETAINED BY:
M(Z. W ILLI n'M V
NAME OF PRINCIPAUCLIENT
1141 tioNitiff ParNT Ro Fri) t, 'Sg‘1RI, 1 V 22511
BUSINESS E AND ADDRESS (Number and Street) (City) (State) (Zip Code)
103) ' O2. i5 Z31 1n�(1 Ir►r�l
TELEPHONE NUMBER FAX NUMBER ( ptional) EMAIL (O ional)
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
i.:PECI FIC LOBBY IOLIIIC 414-1 r Ti erfrce-e., br,
1r.IcttVrS N(a FIEi'jrtl of ROOE °YEA_ IP,ricr dif Mmusi Hoa6E ) AtzrEvANG c3n'Y tiSlb r) IN MA-v.) 1-104E
Issue to be lobbied(Descnbe in detail)
Ill.C,I 1Y A WCIES1 N 1IDU i�..S TO BE LOBB Et:
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
CITY Of Mt nnr 1-evtvw T �, X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familialts5profesisional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or�lty pesonnetWho is
sought to be lobbied as identified on the lobbyist registration form filed. _ —
Sec 2-482(g)Any Financial,Familial or Professional Relationship
C") Ni
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE.(Required) 1 '�i _k; 00 t°(7 j +3 l. 0 .---Oef/7.i fAre)12=?-5-
(R
B) PRINCIPAL'S
uir d)PAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (( `^ / n n�� �� I �� ��'
(Required). �-\WC C-- 1/ A0
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 flNo: Are1you 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 `%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 1544o: Are'vou 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 - EIVED.IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED ERE HAVE BEEN No-EXPENDITURES OR
COMPENSATION DURING THE REPORTING.PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts - e and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami.Beach:City Code:nd all reporting requirements.
Signature of Lobb"'st.
Signature of Principal/Client: `��—
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: i o
— N
El Produced ID 0 Produced ID <`` m 1)
Form of Identification Form of Identition"-
Co '1
:'�•ersonally known(Lobbyist) ,,ersonally known(Principal/;
VII. SIGNATURE AND STAMP OF NOTARY: 7� o _�
`,0.Y P� Stacey Nano T �.J
State of Florida, County of Miami-Dade p�':- •.t -- ,� State of Florida, County of MiariSi Dadg
_:: .�n •n_Ov1dh.,x1CN C D 857752
Sworn to d subscribed before me w .., Sworn a subscribed before me-'
T is of f day . p ex. ,2011 ,:v4....a° [X?i'LS:MAR.10,2013 , This 'a day• IP - 2011
` / .1.
r''''uin°s WW1".AARONNOrARYcom 4 A /
.cure off b is Notary-State of Florida Sig :ture of P /c' otary-State of Florida
Notarization of Lobbyist's signature Notarization o Principal's signature
TO BE COMPttE D BY CITY CLERK'S STAF O Y Q
Annual Registration fee: j Yes[ j No Amount Pai O'�) MCR Date Paid aV
Lobbyist Registration Form received and verified by r
c.lc_Eet.$A1_tar.';'r2N., �_C.LA'':.5-GORt�?5 :.c :�yistAnnua a ,s,r ..+.•"�-c3 :...
Revised 1/11/2011 1
MAMIBEACH
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: —t7.l e, D, COs tnri es
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.
12/ 0111
Signature: Date: