Luis Sousa/Sousa Architecture
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RECEIVED
Of ~p _ City of Miami Beach Office of the City Clerk
J . R 71~ijo~driVention Center Drive, Miami Beach, FL 33139
CiTY CLEm\'s OFF ICE LOBBYIST REGISTRATION FORM
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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, dedsion, 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
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST:
50 USA
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(Last)
LL/fS
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Sovs
Af?cH117
(First)
. A /5{1 stAl I
(Number and S eet) (City)
3C>~373~lf8
FAX NUMBER:
(M.!)
rZ. 1U(t\ 53/30
(State) (Zip Code)
8t5VSAL-@ ~ - /('\G.. 05
BUSINESS NAME AND ADDRESS
SdS'" 37 3 ~(3$
TELEPHONE NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
U-ItS SdVSA
NAME OF PRINCIPAljCUENT:
Z3:fVsA-~jZfl:- /3;7 s;r!~M~1 !t1((dL 3'3( 30
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
,?OS- 37"3 ~t3f!:, ~373(P{<lB SdVsA-Le ~-lfJG'()...s
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
;slfV77f $~H(?:PtCldC Q~
Issue to be lobbied (Describe in detail):
III. CITY AGENOES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
Re2 t bf-J
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
D Ves l-~ Are YOU reDresentinG a not-for-Drofit corDoration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
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1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
D Yes ~ Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGuiDment or services. or on a Dresent
or DendinG award for Goods. eGuiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
Are YOU lobbyinG on a ~endin~ aDDlication for a DeYe~ODment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
DYes ~
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH VEAR, 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. ..... ~
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Signature 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.
~i Personally known (Lobbyist)
Signature of Lobbyist:
Signature of Principal/Client:
VI.
II Prod uced ID
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me rv /
This 7 day of 4L . 20~
M~ (2/a/~ )
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Florida, County of Miami-Dade
Sw and subscribed before me
T s_dayof ,20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
PAULA c,&I DERClN
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FORCLE K'SUSEONLY ^ f. { 1r II '7 l.,(
Annual Registration fee: [><j Yes [ ] No Amount Paid MCR # 'h. \2 'Q 0 7 Date Paid "\ ~ ( - 0 I '
Lobbyist Registration Form received and verified by: C -
Revised 02/10/04 F: CLE \ALL \M IA-M\ BBYIST\LOBBYIST FORM 04