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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, 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 ftLobbyistsW has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST:
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(Last)
~'+I.fS- N €-
(Number and Street)
\.-\.ecichj
(First)
I~ Av'L
(City)
(M.!)
H,Q.W\~ ~I 331 ~
(State) (Zip Code)
BUSINESS NAME AND ADDRESS
(,,~OS 1 S 1-
TELEPHONE NUMBER:
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I. LOBBYIST RETAINED BY:
SA \If; D4de...
NAME OF PRINCIPAl/CUENT:
(P'-t'-t)" Nt. "1~ kIlL ~\ '3~\~<6'
BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) (Zip Code)
(?,o'S') 7 S-I'-", '2-"is' 3 ~ 0 S) J ~ 1- q Co '-\ ~ hedd.,,(4) S~...ec:.~~.~~
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
.
NAME OF CHIEF OFACER, PARTNER,ORBENEACIARY: \-\e..o~ P6\~ - 1::'ll:<<C~.vc,.. PI~e-!c""
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: '-loW'\t...
II. SPECIFIC LOBBY ISSUE:
Do(V\~s. \-\ c.. ~'-\-l'\.t..Y' 5 "".. P C1nd. ~."""i~eY\d..~ p~ ~-h' o"'\oS
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relati.~!.\! ip
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V\ '" ~ "" \ '" V\'\.\
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ('\0 ~c.. (e~"",",, z....~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). SPtIot; ()~
Q,S E)c'pC'wh~ f>1'~C.+O~)
('5 G. t1ot- ~r pl'\)fi +
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbyists On Procurement Issues":
o Yes ~o:
Are YOU lobbyina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a oresent
or Dendina award for aoods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Real Estate Develooment Issues":
DYes
~o:
Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae 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. ()
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SI ure 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.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
l~Produced ID FL Dr /uer {/Cef7St:
Form of Identification
PRINCIPAL IDENTIFICATION:
lJ Produced ID
:1 Personally known (Lobbyist)
Form of I ntification
l:J Personally known (P ncipal) nt- 1
(l0 \\5'
- S' s ~)'-
State of Flo ' a, County of Miami-Dade 0\ oW
Sworn a subscribed before me
This day of , 20_
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn :J,nJJ.. sUbscri~ before me /V /
This U day of /?r/ / . 20J,L-f-'
M</{/?.e -' (J~/~'~
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
....PAUL:.\..Ci.\i.OER.ON........,
.. '~. JEal
lit P1aIldI Ala. Inc
gnature of Public Notary - State of Florida
Notarization of Principal's signature
/
/
Annual Registration fee: [ ] Yes [~ Amount P .
Lobbyist Registration Form received and verified by: c2 ~
Revised 02/10/04 F: CLER\ALL\MARIA.M\LOBBYIST\LOBBYIST FORM 04
Date Paid