Beth Sobol/Council of Ltn Amerc
Mi;wni Bc;.x:h
.,
2lIU3
m
-
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, 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 Ordina.nce 2004-3435. \ _
~~'J \ ~ ~\-\t'\
E OF LOB ST: (First)
'\ 3~ \ ~
(City)
}?Co '4-
,C.v ,..'~
\)".
~ ,.j)
BUSINESS NAME Am> ADDRESS
~~
TELEPHONE NUMBER:
(Number and Street) (City)
(State) (Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Tru~ {Secti~n 2-482.(C)] \
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:~JL~ ~ ~
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY
CORPORATION, PARTNERSHIP OR TRUST: "
R INDI CTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
~~\
II. SPECIFIC LOBBY ISSUE:
~
Issue to be lobbied (Describe i
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/ntle
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPE,HSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOR OTHER): .
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaign Contributions By Lobbyists On Procurement Issues":
Yes
~r..-
Are yOU 10bbvinG 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 Citv Code Chaoter 2, Article VII Division S
thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitl~d "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
Yes
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LImNG LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED G CA NDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BE N ITU 0 PE ON DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoi
familiar with the provisions c ntain . S
requirements.
facts are true and correct and that I have read or am
io 2- the Miami Beach City Code and all reporting
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
PRINCIPAL IDENTIFICATION:
Produced ID ~ A.-~()- DJ3 - Q .- 5111- 0
Form of Identification
= (1.eAy,;~--F~
ppr<:ol1i1l1y Prinel,8l.)..'::.___.___._.
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me 0' I
This 91d day of (l~ 20 '1
~~rida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and sUbscrib. ed before me " /
This~day of ()~ 20~/ -..
Signatur~-~
Notarization of Principal's signature
"..y~ Liliam R Hatfield
! ~ . My Commission 00002020
-.:......,,:1 Expire. February 18, 2005
I FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ V] No Amount' aid - 0 ~ MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 02{1O{04 F: CL LL \MARIA-M\LOBBYIST\LOBBYIST FORM 04
$/~3 Jf) if
. ,