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Home My WebLink AboutAlexander I. Tachmes/Chisholm Mfum Seilld1 , J.003 lD 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 Ordinance 2004-3435. --tAC t+w1~S Ii L- f '(1t,J DEfC.... 2. NAME OF LOBBYIST: (Last) (First) (M.I) At.-iYJ4.v1>'i2. T. 'TACHwff:S, f.lI. ~ S. 0,SCAfAl[ BLV/). J'rf. ~~c /I'IlilMf,fC33/3/ BUSINESS NAME AND ADDRESS . (Number and Street) (City) . (State) , (Zip Code) 3.., s- 350-/14-0 TELEPHONE NUMBER: .$0$"-350- i/?'lo FAX NUMBER: f/X'Tf'Cftwt €S' @WA oC ~W1 EMAIL: I. LOBBYIST RETAINED BY: 1:..tHSH-oLWI p(ZoPfq2TIf.~ S'04-rH ~El1cll, :nJc NAME OF PRlNCIPAl/CUENT: I'll CDU",/NS € . 1tI/ /Irtt f fP[;te tI P- (City) (State 33/3 (Zip Code) BUSINESS NAME AND ADDRESS (Number and Street) 'jo5 -119 - 3ibf 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 BENEFIOARY: f2 0 8 6~7 16/tL-Z-(: B tee I frz e 5', 'D{;I'i"- . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SEt:. ?;)cHIBlr "It. A-rr4CHW fff/tETO INn I NCA(Z.PMA"r~1) tlBeG./,J. II. SPECIFIC LOBBY ISSUE: f2r1't-PL.Prz.A-.f.I..'ff<.- CeIIOI/~ ;,,~.~ U....+- ~""'"' 1--4 J.., C.M~ tf JJ./{~ 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 Relationship /1.11/1'.0/2 f- CcNt"'l/..[rt ON C/if A-tpf/IJ- tJ ON E- fS'rf4+r1crJ ,e (rY ft1"iC(t.~h y's 0(f1 c e) rz3oA/Z.DS ... Ce."VlIrTt;8' Cre cJc~ f7t!-f24'S' IBL n IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISO.OSURE: (Required) h' 3DO / Iv-..., B) PRINOPAL'S DISClOSURE (OF LOBBYIST COMPENSATION): (Required). .11 3 <9 <0 / /u,1.( r Yes n a not-fo.... n r nt. Pursuant to Ordinance No. 2004-3435. sial m n .onor 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach atv Qx:le Olaoter 2, Article VII. OMsion 5 Thereof Entitled "Camoaian Rnance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions Bv Lobbvists On Procurement Issues": yesG 2) Are YOU 10bbYina 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 Amendina Miami Beach Qtv Qx:le Chaoler 2, Article VII Division 5 thereof Entitled "Camoaian Rnance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY lobbyists On Real Estale Develooment Issues": Yes e Are YOU iobbvlna on a Dendina aDDlication for a DeveloDment Aareement with the City or aDDlication for chanae of zonina maD deslanation or change to the City's Future Land Use MaD? V. SIGNATURE UNDER OATH: ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHAU 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 SHAU BE FILED EVEN IF THERE HAVE BEEN NO ~R COMPENSATION DURING THE REPORTING PERIOD. J:571----- Signature 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 Oty Code and all reporting requirements. r:n ,_ n .~ ___ Signature of Lobbyist: ~'(:;tv-. 't' u ~ Signature of Principal/alent: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced ID [J Produced 10 Form of Identification ~rsonallY known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: Form of Identification U Personally known (Principal) Stale of Florida, County of Miami-Dade sworn/to ~ Subscr~;~~ ~ This 0 day of 20~ eJ ":1 t<:i4.. . Signature of Public Notary - Stale of Florida Notarization of lobbyist's signature Stale of Florida, County of Miami-Dade Sworn and subscribed before me This _day of .20_ Signature of Public Notary - Stale of Aorida Notarization of Principal's signature ~'I\ ChriI1InI CclIlnI . )I . My C_1lDGMISI '\'1"./ Expires Slplomber 23. 2005 FOR CLERK~SE ONLY ~ . AnnualRegI-.mfee: [vlves[ ]No AmountPald ~ .DO MCR#~7~'1'DatePald ~o/<5V Lobbyist Registratloo Form received and verified by: .~ Revised 02/10/04 F: Q.ERv.u\MARIA-M\lOBBYIST\LOBBYIST FORM 04 y~s No: r 1) Y~~ ED 2) Yes @) v. IV. DISCLOSURE OF TERMS AND AMOUNTS OF L.OBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): .It I , 'fl' '30'0 ~ A) lOBBYIST DISCWSURE: (ReqUIred) _ 0------------------------- B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired)___tl ;So tLJ k.m ,.___________ Are vet! re resen!]n.... 3 nct-fOT"....!"ofit c:a!'"....m..~t!cn or en!::!:'" ~".'!thaut S.....e.:i3! ::cm......cnsation or ursement. Pursuant to Ordinance No. 2004-3435. Pursuant to Oroinance No. 2003-3393 Amending Miami Beach Otv Code O1aoter 2.. Article VII. Division 5 Tiu.::ftof EniiUt:J "CalllUi:li(..UI FilklllCt Kt;;fUflll" 'Vld i"llt= Mutii(lori Q( Code Section 2,-465 Entitled "'Prohibited Camoaian Cuntribillk>1J5_ftY..!:&t!!2vists .91.LE!:Q(1!@f!tgnt 15su~~~ A.r~..YQY,Ig,~Dvjng.Q.n a present or pendinQ bid tor Qoods, equipment or serviC".es, or on a nresant or oendinq award for Qoods, eauiDmeo.t or.~igtZ :'\.j,"";iJiii,t tv -n..;Jii"ioil":'oC N.j. 20D::.t-33;:; Mil l<:-mJ;1I\..i j.J;,ulli &adi City Cvd~ OlaD[c( 2. Aaticie Vli Division 5 trefe~.f Fnt!t!l'>d "rArnr.::l\(11"'! fir.3nce RefC'~!Tl" Vb !h~ !\dc!t!cr: Of Cede. Sect!on '2 .~90 Ent:tled "Prohib:ted C'..amDaian CnntrirnJtions fiy-lHnQyi5ts Go.. Real Fstat~JEvelQll.rn~nU.s$JJ.~; Are YOU lobbvina on a Dendina aDDlication for a Development Aareement with the City or aDDlication for chanae of zotiinq map designation or chanae to the City's Future land Use MaD? SlGNATIIRF. UNDER OATH: ON OCTOBER 1"-' Of EACtI YEAR, EACH L08BYIST SHALL SU8MIT TO THE CITY CLERK A SIGNEO STATfr-iI;;"'4T UNDeR uAn" Li:SI'.Lhh,:i i.ODD,-'.iIl4b t:Xt"cNlJJ.IUKfS, AS WELL AS COMPENSATION RECfl'SfO, IN T!'U: CITY Of ~..1IAt-1r er::"CH :~-crr THE pn.ECfDn~G CALEN'O~R YEAR. ASTATEr~'ENT SHAll BE EII ED E\lflll TF THFRF H~VF BFFN NO F>(PF~[HTIJr;F5 OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbytst .J Produc..:ed ID I produced 10 Furt" af Identification Form of IdentificatioFI VII, SIGNATURE AND STAM!" 01' NOTllIlY, Personally known (Lobbyist) ~erSOnallY known (Prindpat) day of t This ~"".'-._ ,.f ...',. ..'-'>_. '_""', '~'.' ,. c ~"'.. ".' ~ , .J'-Ql"C; VI I IUI tl"lQ, '-V.....llY ..... I'.""."'-VQV~ $v,fem to and s-DbscrJb-ed before rne _ 20 Thi_ r Signature of Public Notary - SLOt€ of ~londi;J Notarization of lobbyist"s signature e or Public Notary State of Hori l'fotarizatioh of Prindpa''''s signature .#~ vomonO_ r~ . MyCommllllonDD15-1778 "\'1;1 Ex.... October 04, 2006 I I .. , ./ fOR CLFR ! A.~,~~~.~..J!~~~~:.~~~~.€i:~~ _~~~~:} __.,./ f'J~~,_,. ~~'~CJUnt P<1ld , L...-...,"'l....., '"''':"',';',.n.''",,,,,''' .-...,....'.. ...-;-...<......c.... ,;.n... ""u,,<:;...' wi, 1 Revised 02/10/01 F' CLER\AlL. i .. ____.. . --- I 9//..rtJ./ I I I I 's USE ONLY . - '"LK" .2'Z2~lJate PalO IA-MHOBBYlSnI066YIST FORf'.1 04 EXHIBIT "A" cmSHOLM PROPERTIES soum BEACH. INC. Ba1zebre Family Trust Robert P. Balzebre, sole trustee Robert Holladay Robert P. Ba1zebre Johnny Chisholm 55% 25% 10% 10% .