Maria Diez/MB Latin Chamber
b2'.!td
linT'
lQ
fll,.V"l Hr,\ft!
'='(IU3
-
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, resoiution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or cDmmittee; or any action, decision or recommendation of any dty 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 spedfically includes the
principal as well as any employee engaged in lobbying activities. The term ftLobbyists- has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST:
b ie.z
1qar/A
(First)
La"'-;!) Cmrnber of' Comme<<e ff. 33139
(Number and Street) (City) (State) (Zip Code)
(3OS') '1 <f--'1;OS;2.. inb/cceJl:efLsoo-lA. neT
FAX NUMBER: EMAIL:
(M.I)
(last)
k iQn/ BPflrA
BUSINESS NAME AND ADDRESS
C30~~ ~1tf - I'll<./-
TELEPHONE UMBER:
I. LOBBYIST RETAINED BY:
1n/aH; ?;eaJ.... LaJ-ill
NAME OF PRINCIPAl/CUENT:
Chamber oF Comrne1'C€-
UIlC<J(f\ ~ Oa.J.. - /niaHi 'BeatA";>
(Number and Street) (City) (State)
(aOS) Ct,7i.f-/<-{-1l../- C30~)~7<1-q0S2
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
arO
PIA. ~~/~/
(Zip Code)
BUSINESS NAME AND ADDRESS
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
/J I /kS,,-df>fl-l-
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY: Gra...ce. L,...a.. c..>an (,
. IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECfLY, A 5% OR MORE OWNERSHIP ImEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE: V lj ]5tlhr c{
of tJ/1 &'</\./'1- ; /:J
Issue to be lobbied (Describe in detail): ./
~flIL b -( r> fM-) 6"--
Ct'VqVS f
v
oN
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
.
f."CA 7)()::u~d 71lembers 'l)Of)~
D Yes ~:
2)
DYes ~o:
V.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL~
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
{/(9 Jvnft'e ("
k:cu.J.
-rnern bel'"
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
Are vou lobbvina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
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 vou lobbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON- OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE .'. RECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE PITUR R 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 provision tained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
~1U~
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
[J Produced ID
[1 Produced ID
Form of Identification
[i ~allY known (Lobbyist)
Form of Identification
(]..Personally known (Principal)
CUI#// Cfut~ D~ ~
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me I j
This 6'T-tlayof 20J!...7
,
CY .
COMMI5SlON , Dll()q656
EJCI'IRES SEP 07 2005
IlONDED 1ItlOOOH
_NON\'
FOR CLERK'~E ONLY /. 0
Annual Registration fee: [ ] Yes [0NO Amount Paid _ , MCR # II:}-' Date Paid It) fi-
Lobbyist RegistratiDn Form received and verified by: ~ ~ ~ o7/.3-li1, tit/--- --t! -5t)~
Revised 02/10/04 F: CLER\All\MARIA-M\lOBBYIST\lOBBYIST FO M 04