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Robert Goodman/Art Basel lD - City of Miami Beach Office of the City Cierk 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 ~r;d/YJd/? ;(J)y.fl S, NAME OF LOBBYIST: (Last) ) (First) (M.I) DATE QUAUFIED AS LOBBYIST 3::11 4/.s~ Sl-re~ J- ___';./'('7 /7/J/J/ Ab~m~/1~,a;Yr;; J:""/.. d3l~GJ BUSINESS ADDRESS: (Number and Street) / (City) eState) (Zip Code) , /:?tt~ft,73-~~/77) r;gt'./))IP7Q -/.:241-2 ~bn".m~~k.r<V/JcI iaTI>HO NUMBER: '/JJ( NUMBER: MAlL:..f?" CLJ /Y) I. LOBBYIST RETAINED BY: .4H A-:z~/ Mdm/ &07e/} NAME OF PRINOPAl./CUENT: Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)) . NAME OF CHIEF OFFICER, PAATNER, OR BENEFlaARY: n -i -< <::> w .~ ;0 <:> m <: () <::> m ;:,. '< ::r rn CJI 0 ~ . (") r- UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECll. Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH ~ CORPORATION, PARTNERSHIP OR TRUST: :;2;; U') 2 ..,., C") /'TJ u. SPEOFIC LOBBY ISSUE: Vt?~ r;rrl/J!- Issue to be lobbied (Describe in detail): m. crrv AGENOES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/TItle B) Relationship 1. v. U~LV:=lUKI: vr I CKPI::t ArcU Al"lvurc l::t ur LVDD 11.::' I \..v......cn:tft 11un lUl:M..LU:=l1: nncl nCrt nvuru.. f, ,FLAT RATE OR OTHER): ;~;;L"';;'"k:!Y i:~~:;7t;~5hJ~:t/l;~de ,oj: B) PRINCIPALS DISCLOSURE (OF LOBBYISTCOMPfNSATION): -lads. 5e~ ,4.h,y~ 1) Pursuant to Ordinance No. 2003-3393 Amendino 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 Camoaion Contributions Bv Lobbvists On Procurement Issues": ent or services or on a resent 2) Pursuant to Ordinance No. 2003-3395 Amendino 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 Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues": ? V. SIGNA1\JRE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR,. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPE ITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. Signature of Principal/Client. e VI. LOBBYIST IDENTIFICATION: \ ~ o Produced ID W i-e}- i $ I.J t- '<.~~~ ~allY Known Form of lrentification ~ ..,01'':'',,,,, Marisa Bluestone ;tl' * My Commission CC989850 "''!!'!''/ expires December 25, 200A .~ I do solemnly swear that all of the familiar with the provisions 6ntai reporting requirements. Signature of Lobbyist: VII. SIGNA1\JRE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Rorida, County of Miami-Dade Sworn to and subseribed before me This <) day of ~OV - , 2003. ,r ~Vl Signature of Public Notary - State of Rorida MOt VIS?\ ?:')\A'C~tove Print, stamp or type name of Notary Public - FOR CLERK'S USE ONLY Registration: [] ACCEPTED If rejected, state reason: Registration fee paid: [ ] Yes [ ] No DATA ENTRY DATE: [ ] REJECTED DATE: [ ] Cash [ ] Cheel< MCR # .2003 ENTERED BY: 2nd Revision 3/18/03 F: \CLER\HAlL\Lobbyists\registrationa03.doc NOV.12.2003 12:03PM NO. 232 P.2/2 <.tv. UJ.=-\"LU~U""IC: vr I a:::.~,.,::J "'AU "'P'lUU!'1I::1 ur "'UPO,~~t \",uPlrC",:'I\II.UJ' \.U.&.:>I-L-V~~ nnz:tnl:I'C. nULJt<Lr, A / fL4.TRATEOR OTHER): .:;t-:.::rt:::y~ :r " CO',,",:,OlSO-OS"'7 '!Y t<'J~ /("-12,0;"',0< ,7 nJNJ-Ih/'j '0 · t"eJr7.//Jr-f W_ _/ ~r )//ci2s'f 1l .y~v/ <:) tGr /JZ'//kAde c? I'..t- -ra'Si\::5., B) PRINQPAL'S DISClOSURE (OF LOBB"11ST COMPENSATION): Ve., 0 1) ~nt or services. or on 21 oresent 2) ? V. SlGNATtlRE UNDER OATH: ON OCTOBER 1 Sf OF EACH Yl'AR, EACH LOBBYIST SHALL SUBMIT TO THE cITY CLERK A SIGNED STATEMENT UNDER OATH, Ll5T1NG LOBBYING EXPE !TURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.. Signature of Lobbyist: Signature of Principal/Client. VI, LOBBYIST IOENTIFICATION: ( , o Produced ID l21.4' ~c::)- ~ /1 t. szJ,z.$e. Form ofldentifiea~on ue and correct and have read Dr am City Code as amended, and all Personally Known VII. SIGNATtlRE AND STAMP OF NOTARY OR DEPU'TY CLERK: .'.......'<1"" MQri&Q Bluestone ~ L~ ... My commi$Sio~ CC989!50 ';~,l E.plre' December ,5 ,00' "'11"" State of Florida, County of Miami-Dade Sworn to and subscribed before me This <) day of pOv . , 2003. / ~ V1- SIgnature of Public Notary - State of Floricla M Gt V I q... ;2,)\A -r: ~ rove Print, stamp or type name of Notary Publie ~- If rejected, stlte reason; Registration fee pald: [ DATA ENTRY DATE: FOR C1..ERK'S USE ONLY [ ] RElECTCD DATE: I}} I 7/ ()..:S I Registration: 2003 F:\Q.ER\HA11..\t.obbyislS\re91strationa03.dOC [ ] Cash [ ] aleck ENTERED BY: 21ld RevIsion 3/18/03 NOV .12. 2003 12: 03pr'1 Garber & Goodlnan, Inc. Adt!ertisin~/Mar1<elinK, since 1963 301 41st Street, 3rd Floor Miami BMah, FL 33140 Tel. (305) 673-5177 Fax (3OS) 673.1242 bgoadlll4niWgarberandgoadman.oom r,o. 232 DATE: November 12,2003 Elizabeth City Cler1c's office City of Miami Beach P.1/2 TO: COMPANY: FAX NUMBER: NUMBER OF PAGES: FROM: 673-7254 2 (including this page) Diane Goodman As per your request attached is page 2 of the lobbyist form with the disc1OSUl"e amount. I will mail a $25 check today.