Donald E. Kino/Glenna Norton
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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 dedsion of any commissioner; any action, decision, recommendation of the
City Manager or any dty 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.
TELEPHONE NUMBER:
~
(Last) (First)
2,O(f) P\1~~ ~/,. ~~~O
(Number and Street) (CitY) (State) (Zip Code)
"5&1. e,~:z..?44-~ r...E7~~9 f<O~M
EMAIl:
~
(M.I)
FAX NUMBER:
NAME OF PRINCIPAl/CUENT:
LOBBYIST RETAINED BY:
CriGNNlt NORTON
RbAi)
Mffr
fL. 3~/t.fO
(Zip Code)
I.
ti z.~ c> (l:n-l
BUSINESS NAME AND A DRESS (Nu
~05, Q75'.277>
TELEPHONE NUMBER:
er and treet) (City)
FAX~M~E[O~:? .S g 93
EMAIl: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE: I
ef:ev. . V) tdl Ovt 6 t- axrk.l n
Issue t9,be lob~i~d (Describe in sJ.etall): R ~b
to3~G> GVO~t"H ~Ai1 Onr
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, f!!milial or Professional Relationship
a.t..
1>
IV. DISCLOSURE OF TERMS AND A~NTS OF LOBBYI CO. MPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER): (-J ~'- 0
A) LOBBYIST DISCLOSURE: (Required) /)",0 '-I-f ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
nor
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code ChaDter 2. Article VII. Division 5
Thereof Entitled "CamDaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY LobbYists On Procurement Issues":
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 Lobbyists 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 EXPEND 0 COM ENSATION DURING THE
REPORTING PERIOD.
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 contai d in cti 2-482 of the Miami Beach City Code and all reporting
requirements.
PRINCIPAL IDENTIFICATION:
Signature of Lobbyist:
Signature of Principal/Client.
VI. LOBBYIST IDENTIFICATIO
f\ Produced ID fJt/l- rrl.t\.LJiwhi CtvrIL( -
Form of Identification
;( Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of-l1;b,,,j ~adt:.P~ ~
Sworn to and subscribed before me Ll .
This 1.1) day of '- 20.Q.7 _
~roduced ID fi nnrfY /'ee" Se
Form of Identification
[] Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed bef~1 me _/
This -/kLday of A~/ , 20~
h?Lt..u-&//~.0
Signature of Public Notary - State of Florida
Notarization of Principal's signature
COLLEEN A. HINSON
MY COMMISSION t DO 093287
EXPIRES: Marth 22, 2006
BondodT1vu~P_l)KIoIwlteII
./ FORCLER 's S
Annual, Registration fee: [ YJ Yes [ ] No Amount Pa'
Lobbyist Registration Form received and verified by:
Revised 02{10{04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
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