Ira Giller/ Paul H. Freeman
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o Check Box if an Amendment
6, LLE(L
NAME OF LOBBYIST: (Last)
-3tr- 4-1 ~ ~T r
BUSINESS ADDRESS: (Number and Street)
'~.Q.~;b3 24- FAX NUMBER
vZ-A
(First)
M I ~ \ ~'EA-tr< FL r
(City) (State)
I. LOBBYIST RETAINED BY:
_PA-UL H - ~ArlJ
NAME OF PRINC~L/CUENT: ~
(7<:>9r 11'; tMr 7/2At~ Sc
m
-
1>.
~ ~ { 4--0
(Zip Code)
EMAlL:
Ii
BUSINESS ADDRESS:
(Number and Street) (City)
O~\
~~--ano
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
^
3~~
(Zip Code)
EMAIL: (Optional)
Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (e)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFlOARY:
· UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Issue to be~~D~ -:(6 ~8
III. CITY AGENCES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
ftl'1nJf2.rc ~1i)N ~
B) Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A} LOBBYIST DISCLOSURE:
KovvLr
~/5"i'.
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
~"'1
8 /~.
1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaian Contributions By Lobbyists On Procurement Issues":
:~~:~~i~ab:~:~ o~: g-::.n::~i=:~~:rb~:~~;o~~e~~nt or services. or on a Dresent
2) Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Real Estate Develooment Issues":
Are YOU lobbYinG on a DendinG aDDlication for a DeveloDment AGreement with the City or
~~=~r chanGe of zoninG maD desiGnation or chanae to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all
familiar with the provisi 5 con
reporting requirements.
Signature of Lobbyist:
Signature of Prindpal/Client:
VI. LOBBYIST IDENTIFICATION:
o Produced ID tpL.1)'L 1'6/-66 .4-01 ..4-9..0S'3"o
Form of Identification
e foregoing facts are true and correct and that I have read or am
ed in Section 2-482 of the Miami Beach City Code as amended, and all
o Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to a~ subscribed before me
This ~- day of ~ . 2003.
OfflClALNOfARYSEAL
LILLIAN BEAUCHAMP
NOfARY PUBUC srATE OF FLORIDA
COMMISSION NO. DD109289
MY COMMISSION EXP. APR. 29,2006
U
Print, stamp or type name of
FOR CLERK'S USE ONLY
Registration: .t><f ACCEPTED
] REJECTED
DATE:
If rejected, state reason:
Registration fee paid: ~Yes [ ] No ~Cash [ ] Check ;;it
DATA ENTRY DATE: ~ 2003 ENTERED BY ~
2nd Revision 3/18/03 F:\CLER\HAn\Lobbyist5\registrationaOJ.doc