Welcome USA
~
City of Miami Beach Office of the City aerie
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderle@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
ROSEN
NAME OF LOBBYIST: (Last)
407 LINCOLN ROAD.
BUSINESS ADDRESS: (Number and Street)
(305) 534-4757
HAROLD
(First)
PENTHOUSE
(City)
(M.l) DATE QUAUFIED AS LOBBYIST
S.E. MIAMI BEACH, FLA
(State) (Zip Code)
(305) 538-5504
33139
TELEPHONE NUMBER:
FAX NUMBER:
EMAlL:
I. LOBBYIST RETAINED BY:
WRT.rOMR nSA
NAME OF PRINOPAl/CUENT:
351 ALTAR A AVENUE, SUITE B
BUSINESS ADDRESS: (Number and Street) (City)
CORAL GABLES, FLORIDA
(State) (Zip Code)
(305) 441-1231
TELEPHONE NUMBER:
(305) 448-2283
FAX NUMBER: (Optional) EMAlL: (Optional)
Fill out this section If prlndpalls a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
MATT HEGE
. UST ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
PRIVATE PROGRAM REGARDING PROMOTIONAL TELEVISION SHOW
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
CITY COMMISSION
COMMUNITY R~LATIONS BOARD
,cu
,
ANY OTHER CITY BOARD OR PERSON THAT MAY B ~ INVOLVED IN THIS
"
--
PROJECT
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYISf DISClOSURE:
$4<;0 00 ;:'In l1()1]r
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
$450.00 an hour
1)
~:=r"~~~ ~i~n~ N~. ~00~~393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
it! " m ai n ina R~form" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbyists On Procurement Issues":
Are YOU lobbying on a oresent or oending bid for goods. eouioment or services. or on a oresent
or oending award for goods. eouioment or service? D YesxxNo
2)
iu~:n~ t~ ~:inan~~~~ 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII DiYision 5
he f n itl "Ca i Finance Reform"~ Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbvists On Real Estate Develooment Issues":
:: ~~ ~:~~~~n~ :~:. o~n:~~ :o~:~~iO~ for ~ Develooment Agree~ent with the City or
01 tl h e f n ;;~Ignatlon or chanGe to the City'S Future Land Use MaD?
DYes r,po
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
. STATEMENT UNDER OATH, US1lNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Signature of Prindpal/Client:
VI. LOBBYIST IDENTIFICATION:
CI Produced ID
o Personally Known
Form of Identlfication
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ U. day of crx. , 2003.
te of Florida
otary Public
Registration:
~PTED
FOR CLERK'S USE ONLY
] REJECTED DATE:
J$(2f/O <
If rejected, state reason:
Registration fee paid: [ [ 1 No
DATA ENTRY DATE: .11i 7>(
2nd Revision 3/18/03
[ ] Cash
.2003
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