Ira Elegant - Bratter Krueger
Clty of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emall: cityderk@ci.miami-beachJ1.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS ADDRESS: (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CLIENT:
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BUSINESS ADDRESS: (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER: (Optional)
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(M.I) DATE QUALIFIED AS LOBBYIST
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(State) (Zip Code)
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EMAIL:
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(State)
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(Zip Code)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
( LLC J
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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. UST ALL PERSONS HOLDING, DIREffi Y OR INDIREffi Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
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n. SPEaFle LOBBY ISSUE:
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Issue to be lobbied (Describe In detail):
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UI. C1Y AGENaES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title B) Relationship
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'lV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER).
A) LOBBYIST DISCLOSURE:
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B) PRlNCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): tL 'lj' 375".....--
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code (haoter 2. Article VII Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-"\88 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Procurement Issues":
Are YOU lobbyinG on II Dresent or DendinG bid for Goods. eauiDment or services. or on II Dresent
or Dendina award for aoods. eGUiDment or service? 0 Yes ~NO
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2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions By Lobbvists On Real Estate Develooment Issues":
Are YOU lobbyinG on a Dendina IIDDlication for II DeveloDment Aareement witl) the Cibulr
i1DDliation for chanoe of zonina maD desiGnation or chanGe to the City's Future Land Use MaD?
DYes J.NO
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG 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.
"Personally Known
Signature of Lobbyist:
Signature of Principal/Client:
VI. LO.BYIST IDENTIFICATION:
[J Produced 10
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
swor~~subscri~~
This day of 2003.
LESUE MAE REID
MY COMMISSION' DO 134560
EXPIRES: September 8, 2006
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Signature of Public Notary - State of Florida
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Print, stamp or type name of Notary Public
Registration:
[ ~CCEP'reD
FOR CLERK'S USE ONLY
[ ] REJECTED DATE:
1;2/4/3
If rejected, state reason:
Registration tee paid: t;>4- Yes [ ] No
DATAE~YDATE: J2-/es
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i><:l Cash [ ] Check M?5R "J ".7; ::5 V ~
. 2003 ENTERED BY:
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