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Melanie S. Sharee - Film Life, Inc.M 1 A M 1 B E ACH City of Miami Beach Office of the City Clerk 20 14 FEB 1700 Convention Center Drive, Miami Beach, FL 3313Q7. $ I: LOBBYIST REGISTRATION FORM r' 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. NAME OF LOBBYIST: . (Last) (First) (M.I) BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) if 6. 3 E-. Z (Lt Le , ex r 3 6 c 6 - 2oGt Ne lcan i e etHe- ►,ti t . LaM TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. LOBBYIST RETAINED BY: I ru t . NAME OF PRINCIPAL/CLIENT: 6 3rL . 5' t N e > ) (Na toot BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: / (C, 3� S Z( lf(,(AX NUMBER: (Optional) 66, 3 �S Z�CCrEMAIL: (Optional)�Le �Cx �t�� �(� 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.SPECIFIC LOBBY ISSUE: t2 6 1:70(2 fie° 4 -f ) ZO I,� _ 20 6L -(_f 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 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 C Contractual Relationship (Explain) Y YES N NO vc 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 2- 482(g) Any Financial, Familial or Professional Relationship IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 4, 0 (Required). �l 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 ❑'Flo: 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 fNo: 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, sfjall 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 SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF' HERE HAVE BEE ,/' O E ' ENDI RES OR taYCOMPENSATION DURING THE REPORTING PERIOD. Sig ature of Lobbyist I do solemnly swear that all of the foregoing facts are e and correct and th in Section 2 -482 of the Miami B 'c it Code a Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: tj r 414 l fcst,ru -e Produced ID tozuz (a.r. S ltiaust. A-fxM b e) Form of Identification porting requirement ❑ Personally known (Lobb VII. SIGNATURE AND ST N¢.�• `/a �lL N State of Fleri4a, County of Miam Sworn to and subscribed before This q i-h da ave rej .ram familiar with the provisions contained EVANS J LEGROS MUTATE OF NEWYORK ya,, itsIEW YORK COUNTY Dade LIC. #02LE6132876 e 0 M:®(R WNW P@ 23116 Signature of Public Notary - State of rlerida N2w Litz) jC Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: Produced ID Form of Identification ❑ Personally known (Principal) State of Florida, County of Miami -Dade Sworn and subscribed before me This day of , 2011 Signature of Public Notary - State of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: Pi Yes [ ] No Amount Paid Lobbyist Registration Form received and verified by: c rte. 00 MAR# - n�, fc1 F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration orm.doc Date Paid Revised 1/11/2011 02 -29- 12;14:20 ;fiIrni fe 913056737254 ;16463752059 •�vv v � �..• i G•l'Y 2 / t! Iv- DISCLOSURE TERSE AND AMOUNT$ OP LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ) LArE,47'E oR h) LOBBYIST DISCLOSURE: (Regwrpoj E`) PRINCIPAL'S DISCLOSURE (C •4QeayI8T COMPENSATION): I oqulred). Uric following Information sprat arlawared: i) Pursuant to Miami Mach'CIty Code Section 2 -488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement issued "; hr !;I o: Arm ••iy 1 • •••,; . .. a or .endln; . . t•r •..e, ecielpmenf Aervit e? Pursuant to Miami Desert ;Oily Code 2-490 Entitled 'Prohibited Campaign.Contrlbutiona By Lobbyiatr, On Real Estate Develo�nent ranee: •r • at es • •l ' .r "; r . •.•rI • ;11 • C4l0: A n, iAn atio cr Canon , o t o r nt with thg_g aa pllcatiotfor �hng t ofzon tan turn C.otiSLUse Man? Pursuant to Miami Beach City Code 2-484 (h`)•Any person (eucept those exempt from the definition of lobbyist' os set forth in Section 2 -481 above) •wtlo only appears..an -a representbtive or a.. not- for -profit corporation or entity without spacial compensation or roimburseMent for the appearance, whether direct, or indirect, lo express support of or Opposition to any item, aft .11 register With the clerk ail required by this section but shalt not be required to pay any registration fees. Eli • 1;t. iu. • SIGNATURE UNDER gATN; ttFEBR ';,Y28thoF: • r' LISTI a •t eua' •a d r , CH L 8 :. :HALL . al- • a CITY C : K A S O L . + STAY i N ` _ ,:� ..� �: . � r• � � . • �• .t = • ' • ' P ►: ATI • :.. ED k HE'C • F iyf IAl4 a• AC :+fie- ri''-. q.SATI!,i•Pl:�:( fit :?•�• - 1•D,,;�:- .ir2i�1] /dill %a L1 +��i • E rE .t ')=3 Alb if .Sig re of Lobbyist foregoing facts are r; and corriact.and th- eve re' `f .r am familiar with the provisions contained o Code a:: :porting requlremen •.. �:� stir P• INC115k IDENTIFICATION: entl wl.touts 1: 1 com n • tion or rat bursemorrt, . I t Io solemnly swear that all of th Beetles 2.482 of the Miami S linature Of Lobbyist Si 'nature of Principal/Client VI,: // _ .;f� LOBBYIST IDENTIFICATION: &IT :4.► ec.*,,ti. e, Produced 10 Wet voNft. 41,624.Li. 4440 in Faris of Igirttlication ❑ Personally known. {Lc VI ;• SIGNATURE AND ST Na.+. Ycu& ''p 8tti e.of Fes. County of irn to and subscribed before, Th�n•Q�-h da F.1C • EVANS J 1.201106 'gip TATE OF NEW YoR W l YoRi collar' 1@ Fe of =,ub c iota ' -S e. - Flbrid - ; 4.-- y X ;_.�_. rgnature otPU6lic Nota State of . Irt'Lation of 1,{obbYtllt''u'at8rtatirfe' rut -FeIoricla t� t �v `re l WotarozAtiati of nci signature TO BE COMPLETED BY CITY CI.ERK S STAFF ONLY i ealetraUon re.; •E ' Yob't. •kl�n Amount Paid - ft p a R A �%r�rrZ��� tR letretton F;o , w1'o-iibri /+edinod ray: 1t'!1:'i!` _ L � ER \SALL \aFORMS \LOett,YIST Pont0 \robbytotAnnual R•.letrylton orm.dtu Produced ID r� LfC,. •� 4h I�'� .1 :i;�i,<� -• Form of Iden Pi Ion Ii•n'. - �.r',7_,,ya, li. g.-1(Jc .Personally kn NS J LEGROS NOTARY PUBLIC STATE OF NEW YORK tU,� Vun1� {DEWY• K •UN1Y Slate of Fforida, C only of M . f r'. 32878 Sworri an subs • d •r sr. i c UST 29, 2010 Th Is.. '4•0ay of 1 -( -.. 1 Date Paid Revised 1/11 /20x1 TOTAL P,02 x., ;1. 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: Stc-frq---e-C- 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 CIer'Office of lobbyist withdrawal in writing. ture: oczi 0A1 r2_ Date: Misce. apeQpu Ca o ` Mi4M B Receipt v-3 2g 631 0 Cash D Credit Card ddress r, k #:i " 20I HIS INFORMATION MUST BE COMPLETED Account; Number: Preparers Dept: ffice of Finance Director,;