Wayne M. Pathman - Greensquare, Inc. MIAMIBEACH —i
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
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Lobbyist means all persons employed or retained,whether paid or not,by a principal who seeks to encourage the passage,rd�feat'"-
or modification of any ordinance,resolution,action or decision of any commissioner; any action,decision,recommendation of theme'
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.
12 at-hman Wa;mP M
NAME OF LOBBYIST: (Last) (First) (M.I)
Pathman Lewis LLP 2 S. Biscayne Blvd. 24t
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-379-2425 305-379-2420 wipathman@pathmanlewis.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Greensguare, Inc.
NAME OF PRINCIPAL/CLIENT:
P.O. Box 615 Miami Beach, FL 33119
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-673-7761
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,partnership or Trust[Section 2-482(c)]
V 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:
II. SPECIFIC LOBBY ISSUE:
Vendor agreement for operation of city tennis centers (F1_aMingo Park
Issuedtf'ftV Rs"S&N8 4Pll)Park)
M. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A)Full Name of Individual/Title B)Any Financial,Familial or Professional Relationship
Administration
Commission
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER:
A) LOBBYIST DISCLOSURE:(Required) Hourly
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):(Required). $400
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":
N lobbying n a uEesent n in f r goods,eguipMent or services,or o
resent orpending award for g2ods,a ui ment or lervice?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real
/Estate Development Issues":
oYes D'No: Ar you lobbying on a agriding aoolication for a Development Ag arrient with the City or
applicition for change of zoning map designation or change to the City's Future Land Us e
ME
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 cleric as required by this
se 'on but,shall not be required to pay any registration fees..
El Yes No: re our sentin not-for-profit corporation r entity special m ens tion
Z
r reimb men
V. SIGNATURE UNDER OATH:
ON OCTOBER 15T 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 P EDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND OR COMPENSATION DURING THE
REPORTING PERIOD.
re o Lobbyist
I do solemnly swear that f the foregoing facts a rue and correct and that I have read or am
familiar with the provisions containe 'n Section 2- 2 of the Miami Beach City Code and all reporting
requirements. ��
Signature of Lobbyl � Wayne Pathman
Signature of Principal/Client: Victor Weithorn
VI• A TRIPONEY PRINCIPAL IDENTIFICATION:
:•'��� UB` Notary Public-State of Florida
p g. 015 ❑Produced ID
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55 Form of Identification o
:9r po mis
; °•'� ational Notary.Assn.
Pe ❑Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade T -'" 7i
Sworn to and subscribed before me Sworn Iand subscribed before me T;
This 2 3 rdfty of 2013 This��day of Oct 20 13 ;� w ~.✓
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Signature of Public Notary-$ to of FloridN Signature of Public Notary-State of Florida
Notarization of Lobbyist's signature j Notarization of Principal's signature
FOR CLERK'S USE ONLY 2�. f ?'
Annual Registration fee: [ ]Yes[ ]]No Amount Paid k MCR#32- J —Date P ' I 0
Lobb ist Re istration Form received a'nd verified by:
F:\C ER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc Revised 12/08/04
10-24-'13 11.22 FROM-SUNTRUST 305-674-5201 T-055 P0002/0002 F-752
W. DJUGLOSU112 Of T1ER14S AHB AM®UNnOFt.050nST00MPRNaA11ow(61SCLOSI!WIIEWER HOURlY
FIArKAW OR 0YN&AA
A) t.+DaWSP PLgMOSURE;(KeWlred) Hourly
a) PRfNC ews oisaosum(or r:ot3amse coMmsA ):(Required), $400
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The following inforrrratlon Dtustbe answered:: �
1) Ptrstiartt to Miami Seat:b Lity Code Suction >B lrntiiied"plhibited mpaign ContrihaB®rte Lobo Isis'
Il `_, ,
On Procurement I ssuee1« 9
presen&orerendlrm BMW JOrffi®erts,e�uisk ll SIC.
2) pursuant to Miami BeaM City Code 2-490 Entitled`fthlbRed Campaign Contri1130ons By Lobbyists On Real o
Estate Development Issues.,
rives 0406. Are yau'OnAui gum Handin n
upygrallMD _ghanfle Rf xg0jUg MR deslanatiolk v
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3) Pursuant to Miami Beadh City Owls 2°484 (h)Any person(except those exempt from the definitbn of
lobbose as set forth.ra Serteon 2 4st above)wim only appears es a representative of a noMr-profit
corporation or enuty without 5peclai compensation or reimbumment for the appearance,whether direct or
IndfreM to expraw support of or opp000n to any Item,Aar regista with the deck as mqulred by this
se on but,shairnot be required to pay any registration fees..
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V. SIGNATU ti:UNDER DATHi
ON OC OBEit 1�7 OF EACH MAv EACH LOPSYM SHALL SUB141T TO THE CffV CL9RK A SIONEO
STATEMENT UNDEK OAT.K LIEU dG LOBBYING EXpIENDITUR�f AS WELL AS f014PENS�►' 01d
RECI p,1W THE WV OF mlml BEACH Fait THE PRALrDINa CALENDAR YE IL A.STAIrEm y
SNP UE FlUp tr:vgN IF THERE HAVr;BEEN NO RXP OR Cot4pENSATION DURING THE
REPORTING Pi±4 011).
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i do soremM swear that the fb Bg facts rue and canr and ftt I ham read or am
familiar Wth the provl5lons contain n Sec lart 2- 2 of t�Miarml lead City Cody and all repaMng
re�utt'ettretl0�.
Slgnature of Lcibb
Signature of principal/0'ent; AM Victor Weithorn
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aryAaan. p per5pnalty la+own(prtncrpa!) `! Y P .,�., JENNIFER flAMiREZ
z Notary Public-State of Florida
VIL SIGNATURE AND STAMP OF NOTARY= �� ' - my Comm.Expires Jul 25,2014
'�.,;ll�l���,•`` Commission#EE 2431
State of Florida,County of fMliaml•pade State of Florida,County of Mlam+
,ram to and subscribed before me Sworn and subscribed before mfr
Ws 23r of "Chia day r7 .tov[gnaht of pubE�Notary— Ge of�lorrd Sfgrrattme of P bi ty f lb Notarization of LobbylWa signature Notarization of Princiipals sgnature
FOR CLERICS USE ONLY
Annual Raodmthnieat C )Yes[ ]No Amount PaId MCA# DidePidd
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F;%CLERWAUVUA1ArM%cbWALQ00WSr fWM 65,dac