Michael Larkin/Tapas y Tintos
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City of Miami Beach Office of the City B&f E , V ED
1700 Convention Center Drive, Miami Bea~ F.~t:p~l3<<:li110: 54
LOBBYIST REGISTRATION FORl'tITY CLEEK'S Off ICE
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the
prindpal as well as any employee engaged in lobbying activities. The term -LObbyists- has specific exclusions. Please refer
to Ordinance 2004-3435. I Q r!{,/J /IJ; d1~J LJ.
NAME OF LOBBYIST: Iflast) (First) (M I) '3 /
t7P[r,u-J cf--~C{~II PH- ~q) /Sl-v~l 177J((,\t1{ f)~{ uk gSo ,rit,(t!7t fl. j3/
BUSINESS NAME AND ADORESS' (Number and Street) (City)./ (State) (Zip Code)
-
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TELEPHONE NUMBER:
FAX NUMBER:
EMAIL:
I.
LOBBYIST RETAINED BY: /i:
~~C;S 'I- I/Y;hu
NAME OF PRINCIPAl./C NT:
F{
/39
(Zip Code)
/?7.
. [o</V)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY: Iv Ie "JtJ JU>fv) f'er(7(.~d 0 O;~Y\.eL
. IDENTIFY ALL PERSONS HOLDING, OIRECTL Y OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
mJ.sce I/Cf
Issue to be lobbied (Describe in detail):
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III. CITY AGENCIE5/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RA TE OR OTHER}.
A) LOBBYIST DISCLOSURE: (Required)
,j ,J~.(jJ
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(f)cvf \,'1
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$ 3U), (1)
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tion or
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required),
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
o Yes ~NO:
Are you 10bbvinG on a Dresent or DendinG bid for Goods. eGuiDment or selVices. or on a Dresent
or DendinG award for Goods. eGuiDment or selVice?
2)
Pursuant to Ordinance No. 2003-3395 Amendina 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
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
/141 ~/ ~
Sig1lature of Lobbyist
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 and all reporting
requirements.
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Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
LI Personally known (Lobbyist)
.755:;J..,;;~o '7.;l./70.Q
Form of Identification
o Personally known (Principal)
~roduced ID Cb1!5=. ,SP ~ 7 ~.o IIl-PfOduced ID
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before jT1e I~/
This /7 day of~V~ . 20~.,
A/k&- ~
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me ~ /
This L2-day of A?A'It!C#, 20~
~~.ef- ~.
Signature of Public Notary - State of Florida
Notarization of Principal's signature
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PAULA CAlDERON 5
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~'J"IlI.\' FkxtdII Nat8Iy ~.. me -.
................................-.......
IST\LOBBYIST FORM 04