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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 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, dedsion 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 ftLobbyistsH has specific exclusions. Please refer
to Ordinance 2004-3435.
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(Last) D A
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(ELrst)
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NAME OF LOBBYIST:
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(State) (Zip Code
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EMAIL:
TELEPHONE NUMBER:
FAX NUMBER:
I, l LOBBYIST RETAIN~D BY:
tJ. \ ~ JO (fw Lv", )()
NAME OF PRINCI AljCUENT:
~J-on ~J(~:r~ {~D('~
BUS NESS NAME AND ADDRESS (Number and Street) (City)
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FI
(State)
Ifh 2 UVI S
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(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (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 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY ISSUE:
d(t;...-, n
lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
II,
Je.-<"
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
1)nD
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ ift2G,~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Re~ ~ ~ ~ (?
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~
o Yes II No: Are YOU reDresentinG a not-for-Drom corDoration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chapter 2. Article VII. Division 5
Thereof Entitled "Campaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaian Contributions Bv Lobbvists On Procurement Issues":
OYes 0 No:
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 Amendina Miami Beach City Code Chapter 2. Article VII Division 5
thereof Entitled "CamDalan Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Development Issues":
oYes Il No:
Are YOU lobbyinG on a DendinG aDDlication for a DeyeloDment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
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.
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.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
C1 Produced ID
11 Produced ID
Form of Identification
Form of Identification
: i Personally known (Lobbyist)
[J Personally known (Principal)
VII, SIGNATURE AND STAMP OE-NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 20_
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
~ FORCLERK'SUS~ONLY II _ ,/
Annual Registration fee: ('-"'fyes ( ] No Amo n Paid Ifi(),1Jt) MCR IiX 6 h tJ 'V.;LDate Paid ~tJ -0..,.
Lobbyist Registration Form received and verified by: .
Revised 02/10/04 F: CLE LL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk@ci.miami-beach.f1.us
AFFIDAVIT
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 ANY CITY BOARD OR COMMmEE; OR ANY ACTION, DECISION OR RECOMMENDATION
OF ANY 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 COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A
LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: -L1~r-\.\"5CY\ 5'\.)2.e. "~L
Last Name First~ame Middle Initial
Business Phone ~ GCC -=J - ..5 q t../ t-f.-- Message Phone (_) 5' A- M b
Business Name and Address: 5\)3"'1'-\'" l1o..r..h""-S'o...... rAl{~\'-L~o.k-s
7 q II "'S'VJ 5b-i' Ave "'- ve -----tt l~ ~ t f" L
No. Street Suite City State
Email Address:SI.Y.\O\.W\."&\....^.ef€)L..e..1I -5"0" +L., . r. -c...-+
2) Principal Retained by: \J 1\ l ~ e \ HCc.-...- eo--. AD y,..-.t' kl'U\A..
1'1.00 Pt ~ ~ ~c.. ",-.d. ---DY" \\L
If different from above Street
~S~..--- t t;/ Co. Vi c!.. . y<--
City ( State
3'S( 3t
Zip Code
I+-<: <;' 0""). f c- .\< c.,
Fr.sl.a..- Islc.._~ co",~o. ~'..... j\J(J,
Suite 5, (J'\<: .
3,~(3 '1
Zip Cooe
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
beneficiary or interests.
3) Subject Matter (Describe in Detail):
C)~fOS\-\:~ ~ ck \J~L~r~ ....J-
fv-n \DOSC-I t.
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4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: 1\. If) () (
, ..lLfS t 3 h '(JHJ(~u,:) ~ C.
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
on . 2001
on , 2001
on ,2001
on A.p>" tl 2c), 20cAj
on , 2001
on , 2001
Q The City Commission
Q City Commission Subcommittee
Q City Staff
~City Board or Committee deSf-SL.. iPVI"t'--J l3.L
Q Personnel
Q Identify Others
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above: I\\~~
ON OCTOBER 1 ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 he Miami Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
.J Personally known
~roduced ID
Identify
u Did take an oath, or
K.. Did not take an oath
State of Florida, County of Miami-Dade
Swortt~and subscrib1tb:f.oreome rl1[
This ~day of ~ 20'7
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'.-I j:;: CO;I.,\{j::.s:-:),\J NUMJ::';:
'17.. Q 00036311
",(- ~ ~';"'y."
, Or: f\O"" \.-::e'l,f\'i!~>SiON EXF;;'~_~j ,
.iJ,Y 1J?r"<
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: [] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit Organization
[ ] Cash [ ] Check MCR #
DATA ENTRY DATE:
.2001
ENTERED BY:
lO
.
. .-- CITY OF MIAMI BEACH
BIENNIAL LOBBYIST REGISTRATION
DATE REGISTERED: ~, 200~
LOBBYIST NAME MQ""+~
LAST NAME,
c \...,) 2-", "'"...... C-
FIRST NAME,
MIDDLE
S' Vz..", "''''''~ t1.'l....+\~<.:l '""\ ~ I{"o-t....t-ev+:>
(IF DIFFERENT FROM ABOVE)
BUSINESS PHONE (3c>~ c,G -q - .3'1 i-fl-J
MAILING ADDRESS -::rq II Sw 55 -b ft-v-<-
BUSINESS NAME
t-'\rR~r '. pi- 33/43
BUSINESS ADDRESS -:; 4-.PI G
I 00 SOLEMNLY SWEAR THAT ALL FACTS CONTAINED IN THIS BIENNIAL REGISTRATION REPORT ARE TRUE AND
CORREa, AND THAT I HAVE READ AND AM FAMILIAR WITH THE PROVISIONS OF MIAMI BEACH ORDINANCE 2000-
3243 (AMENDED 5/10/00), AND THE LOBBYIST REGISTRATION, REPORTING, AND WITHDRAWAL REQUIREMENTS
CONTAINED THEREIN.
.
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
SWORN TO AND SUBSCRIBE~ BEFOF,E
ME THIS.J q-r'>- DAY OF ~~r-ll ,200{f
NOTARY OR DEPUTY CLERK
BIENNIAL REGISTRATION FEE $125.00
PAYABLE ON EACH EVEN-NUMBERED
YEARS
PAID $
DATE
CASH _ CHECK _ (CHECK #
REC'D BY:
)
DEPUTY CLERK: