Robert Orban - A Nany Blue...
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@ci.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
D Check Box if an Amendment
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(Last) (First)
Pj.1A{ t,,~ D..... w\t"MI
(City)
61
(M.I) DATE QUALIFIED AS LOBBYIST
FL ~ '/eltl
(State) (Zip Code)
p,o\1(, (' ~
NAME OF LOBBYIST:
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BUSINESS ADD ESS:
("3~ 2..ClO'" 7. 11;>0
(Number and Street)
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
A }Jo.w..A QllA.<" ~III\~~
NAME OF PRINeIPAl.JCLIENT:. I ~
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14. Co M.A("~ ,""JM L I
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AI fcM. Pad.
(Number and Street)
~ l- 2..-lS '2-$
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flt\1"MI ~4C.t1
(City)
FL
(State)
3=5I,cr_
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
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Fill out'this secti~n if prlhcipalls a Corporation, Partnership or Tnist [Section 2-482 (c)] I I
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. NAME OF CHIEF OFFleER, PARTNER, OR BENEFICIARY: 6)~., I {" yV\
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LIST ALL PERSONS HOLDING, DIREcrL Y OR INDIREcrL Y, A S% OR MORE OWNERSHIP IN,TFREST IN SUCH
CORPORATION, PARTNERSHIP OR 1RUST: (.. I ~: (~.....-t eN' C Wold I
II. SPECFIC LOBBY ISSUE:
(.,If-PClS i}ft.t'\. 40 Va.iAecNtc.<.
Issue to be lobbied (Describe in detail):
m. aTY AGENCES/INDMDUALS TO BE lOBBIED:
, . .
A) Full Name of Indlvldual/T1tle ........, ,. ''8) Relationship
'N. DISCLOSURE OF TERMS ANO AMOUNTS OF LOBBYIST COM NSA nON (DISCLOSE WHETHER HOURL Y,
FtATRATEOR OTHER,) "(llAr J--.:a.,/. (j h V
A) LOBBYIST DISCLOSURE: t1' ..p / lJI
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
$~()
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1) Pursuant to Ordinance No. 2003-3393 Amendin9 Miami Beach City Code Chaoter 2 Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-'188 Entitled "Prohibited
Camoaion Contributions Bv Lobbyists On Procurement Issues.:
:~eD:::i~~b:::~Of:: aO::::~::~i~;ie~~:rb~:::~:O~~e~~ent or services. or on a Dresent
2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion FinanCe, Reform., Viii Tbe Addition Of Code Section 2-490 Entitled "Prohibited
, Camoaion Contributions BY Lobbvists On Real Estate Develooment Issues":
Are YOU lobbyina on a DendinG aDDliation for a DeyeloDment AGreement with the City or
.DDliation for chanGe of zoninG maD desiGnation or chanGe to the City's Future land Use MaD?
DYes ~o
V. SIGNATURE UNDER OATH:
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ON OCTO.E'R 1 Sr OF EACH YEAR, EACH l()BBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, UsnNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I 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 as amended, and all
reporting requirements.
X Signature of Lobbyist:
.x Signature of Principal/Client:
VI.
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LOBBYlSTIDENTIFICA N:
Produced ID (I~d CL J)~jv~l~ UUrl~
Form of Identlficati9n
,GJ,J Ij;
o Personally Known
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VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ,Jnd day of Oe--l-o b,e.....- . 2003.
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Signature of Public Notary - State ~ Florida
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MARlENE MELENDEZ
MY COMMISSION f CC 952916
EXPIRES: July 4, 2004
Bonded Thru Notary Pubic Un4elWriters
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Print, stamp or type name of Notary Public
Registration: p6 ACCEF"reD
If rejected, state reason:
Registrabon fee paid: (\,offf:5 / ] No
DATA ENTll.Y DATE: J 0 ~ Q.3
FOR CLERK'S USE ONLY
REJECTED DATE:~
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[ J Cash [vf Check
.2003 ENTERED BY:
2nd Revision 3/18/03