Peter A. Saliamonas - Miami Avenue Holdco, LLC EACH
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. Pleas efer to Ordinance 2004-3435.
4 aMn�o a fib/
NAME OF LOBBYIST: (Last) (First)
I AMi "-e rJ Lt! 5aS l4/n �'dr/ �4►�7� Y� �7, aFz- J ��
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
30S-67a-61Yo2 305'-6?a- s57 ('OS TELEPHONE NUMBER: FAX NUMBER n, /w b o11.,a
..
EMAIL.
Please notify this office if your contact information changes:address, phone, ore-mail address,
1. LOBBYIST RETAINED BY:
d4*n W17Ge (110 tic
NAME OF PRINCI AUCLIENT: /
C� 4t
BUSINESS NAME AND ADDRESS (Number and Street) (City) (state)
(Zip Code) .
TELEPHONE NUMBER: FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section rt 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:
11 SPEOIF:I.CLOBB1(iISSUE.
� E L
Issue to be lobbied(Describe in detail) ` n^ ~ ^t'sM4 'ilC
Ill.C:ITa'..AGENCIES11NDIVID.U_AL'STO BE'LOBBIED:
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
commencement of service with the cite to the resent date,statin the eneral nature of then subject contractual rela ionsh Ong such person's
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of p erson to be lobbied
uJ o.p
Pursuant to City Code Section 2-482(0)Every registrant shall be required to state the extent of any bus nes ;fioanci;Pu Ili I rofessional
relationship, or other relationship giving rise to an appearance of an im impropriety,rie with an current ci. c�omm'ission%�or c t'�14�
sou ht to be lobbied as identified on the lobb ist re istration form filed. p ty y ty y Personnel who is
Sec 2-482 Any Financial, Familial or Professional Relationship
IV.
DISCLOSURE E OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER).
4 LOBBYIST D!SCL 'SURE (Required) F,
&e
B'; PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION) /-
(Required)
The following information must be answered:
�) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On ?rotor=merit
Issues"!
yes No: Are VOU lobb in on a resent or -ending bid for good s a ui merit or services or on a resent or ending
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 endin a lication for a Development A reemerit with the Ci or'a lication for
change of zoning map desi nation 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 ou re resentin q a not-for-profit corporation or entity without s ecial tom ensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH PENDITURES AS WELL AS COMPE STATION RECEIVED CLERK
IN THE CITY OF MIAMIIyTBEACH FOR
OATH LISTING LOBBYING EX
THE PRECEDING CALENDAR HE R YE ORTING PERIOD SHALL BE FILED EVEN IF THERE HAVE BEEN N• EXPENDITURES O
COMnENSATION DURING T
1 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 Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyis .
Signature of Principal/Clien \
Vl. LOBBYIST IDEN FICATION:
PRINCIPAL IDENTIFICATION:
/�L{ S'��re•(��'(09'0�7-� �Pr duce•qd D
Produced I D rW r� Form of Identification
Form of Identification
..........; ISABELSATCHELL c1 al ELSATCHEU
�: ❑ Personally k P aSAB
Personally known (Lobbyist '.: .- MY COMMISSION M M 879891 ;;a�'r ' ': MY COMMISSION 113 2013
h '•. o EXPIRES:April 13,2013 ''+ EXPIRES'.APriI 13,2013 hers
' AIgTa edThruNot rfPuhlitUnderwriters ; °= BondedThNNolaryPubli�Under�
VII. SIGNATURE AND STAMP
2F .•
Mate of=lorida. iami-Dade
State of Florida, County of Miami-Dade Sworn aad subscribe e�ore me
Sworn to a d subscribed -ef e me This ��D-day of 201j)--
This day of-• 201�.
Florida Signa ure of Pu It otary- State of Florida
Sig e of Pu is Notary- Stat f r Natal zation of rincilaat's signature
Notari ation o Lob_ b_ Vist's si nature
TO BE COMPLETE BY CITY CLERK'S STAFF ONLY Date Paid
No Amount Paid 5 O MCR#
Annual Registration fee: ] Yes [ ] ,
Lobbyist Registration Fonn received and verified by: Revised 1111;2011
\C_�P.ISALL`.a=OTtMS\L`JBB:ISM Annua!Registration Form.doc
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, WW\, .miomibeochfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1., Fax: 305.673.7254
LOBBYIST NAME: Pe I</
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.
Signature: Date: