Jennifer McConney/Maefield Hldg
.- -
ta
~
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 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
~Lobbylsts. has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
McConnev
(Last)
Jennifer
(First) (M.I.) DATE QUALIFIED AS LOBBYIST
17100 Collins Avenue
BUSINESS ADDRESS: (Number and Street)
Sunny Isles Beach Florida
(City) (State)
33160
(Zip Code)
305-945-3636
TELEPHONE NUMBER:
305-945-3737
FAX NUMBER:
EMAIL:
I, LOBBYIST RETAINED BY:
Maefleld Holdinas LLC
NAME OF PRINCIPAUCLlENT:
1526 Blueiav Way
BUSINESS ADDRESS: (Number and Street)
Los Anaeles
(City)
Califomia
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill aut this section If principal Is a Corporation, Partnership, or Trust [Section 2-482 (cl]
? NAME OF CHIEF OFFICER. PARTNER OF BENEFICIARY: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Desian Review Board Aooroval
Issue to be lobbied (Describe in detail):
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
AI Full Name of IndlvldualfTltle BI Relationship
JOl"!le Gamez, Director None
Thomas Moonev None
William Carey None
CA N:
~ced ID /.httltrl(l !Y~ U~
f Form of Identification
r::;.......-,
i~~"1\ .
: ~~~J !
: ~,.~, :<':
i ""111\\ c.::
i f q
ii ~ ;- ... j
l~f ~ Zl ;L 1..J
.J - --.. 07':
J I~ i ~ gi
~ ~:
.
.................:
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $150.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$150.00
n Yes 0 No: Are YOU reDresentino a not-for-DrofIt col'DOration or entity without sDedal comensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
pursu~nt to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chanter 2. Artide VII. Division 5
Ther f Entitled "Camnaion Finance Refonn. Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoalon Contributions BY Lobbvists On Procurement Issues.:
DYes 0 No: Are YOU lobbYinG on a Dresent or endinG bid for GOods. eoulDment or services. or on a Dresent
or endlno award for Goods. eaulDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach atv Code Chanter 2. Artide VII Division 5
the~;;t Entit~ "Camoaion Finance Refonn.. Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camnaion Contributions Bv Lobbvists On Real Estate Develonment Issues.:
nYes :l N:~:e yOU lobbyinG on a aendlnG aDDllcation for a DeyelODment AGreement with the City or
lI~tlon for chanae of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON ocrOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT
STATEMENT UNDER OATH, LImNG LOBBYING EXPEN RES,
IN THE CITY OF MIAMI BEACH FOR THE PRECEDIN L ND
EVEN IF THERE HAVE BEEN NO EXPENDITURES OR M N
THE CITY CLERK A SIGNED
WELL AS COMPENSATION RECEIVED,
R. A STATEMENT SHALL BE FILED
N DURIN PORTING PERIOD.
or and that I have read or
iami Beach City Code and all
Signature of LObbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTI
~roduced ID F{. Vi/. L-/r~
f Form of Identification
r.........._~ Personally known (Lobbyist)
III1 i I. SIGNATURE AND STAMP OF NOTARY:
I "'II tate of Florida, County of Miami-Dade
1 I worn t~~..>l sUbscrib~efore me /It''/
i ~ . J l his --.L.tL-day of ') nj/ . 2~~
lL e. ignature of Public Notary - State of Florida
51 Notarization of Lobbyist's signature
o Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn <j.Fl~ubscri~fy~e 0'//
This --frtLday of' 'a 20_~
/JJ/dA- (}o//~,
Signature of Public Notary - State of Florida
Notarization of Principal's signature
1 First Revision - 05-17-02