Michelle Alberty / MTV Networks
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Miami Sc:iId1
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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, 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.
NAME OF LOBBYIST:
.AlberT,/
(Last) ,
.
MIchelle
(First)
(M.!)
M Tv' N CTWOrlC:;' L-Cttl~ ~mCl~.Jrc. III ( J...irLoln QcocI. M ~drnl' L:a::rch 11- .3~1 ~,
BUSINESS NAME AND ADDRESS (Number and Street) . (City) (State) (Zip Code)
TELEPHONE NUMBER: (305) 5:> 5 - 38(" I FAX NUMBER:~?Cf5) 5 ;, S -
I. LOBBYIST RETAINED BY:
MlV Ne-r-vVDrlc~Lot-,ri 4~n~ .Irr:.
.
NAME OF PRINCIPAL./CUENT:
EMAIL:mIG~I.le. a\bCrtye
m-tv b-ra-fT: CCXYl .
ctwDn(~Lahn' mer/eel.::me. 1/ IlL,
BUSINESS NAME AND ADDRESS (Number and Street) (City)
TELEPHONE NUMBER: (~) 5 ~5. .~ "1 (X) FAX NUMBER: (OPtional)~~5)5? S - (., ~Il EMAIL: (Optional) M 1ViA . c O(Y)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
.
,
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ScoT McP-::nd t:.
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:\j (Q [.'crn I J.nc.
II. SPECIFIC LOBBY ISSUE:
, "- ".
\ ' . ' .. If
~\\ocOhon of-Ar-ant~UonI6.: Mlnml Plrorh t Convrntlcn ALrtnordY-hm~ Ar:J\/(Jrxcm~f"T't-
Issue to be lobbied (Describe in detail): ~
Ir~rQrn
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: V
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
MI~::1l'11 L:>coch Vci>ltDr Clnd
Corwcntl on Authori tv (VCA) .
I ,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) tJ 0 c om pen ~I c::::n ...
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). rJo c..cn1(":::t-n~x::l't((:l(l
Yes~: Are YOU reDresentinG a not-for-Drofit cOrDoration or entity without soecial comoensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
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
Campaian Contributions By Lobbvists On Procurement Issues":
1)
Yes ~:
2)
Yes ~
V.
Are YOU lobbyinG on a Dresent or oendinG bid for Goods. eauiDment or services. or on a Dresent
or oendinG award for Goods. eGUiDment or service?
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaian Contributions By Lobbvists On Real Estate Development Issues":
Are YOU lobbyinG on a oendinG aDDlication for a DeyelODment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe 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, USTlNG 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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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 City Code and all reporting
requirements.
\r--
LOBBYIST IDENTIFICATION:
c- ~~
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PRINCIPAL IDENTIFICATION:
Signature of Lobbyist:
Signature of Principal/Client:
VI.
...
c....
Produced ID
Produced ID
Form of Identification
Form of Identification
Personally known (Lobbyist) .;
Personally known (Principal) /
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ,~ day of ~cpr . 20Q..+
Signature of Public Nota - State of Florida
N . . ,.
~"'''''''' ~ PREGO
......'~yp(J,I"
l~m~ \~\ Notary Public - State of FIoIIda
! . . . !M'ICcmnIIiClI ,&peIhlg 11,2<<D
"a~ ill Commission # 00346272
"",,9r.~,'"'''' Bonded By NatIonal Notary Assn.
State of Florida, County of Miami-Dade
Swom and subscribed before me
This ~day of ~ . 2004
--
Signature of Public Notary -
Nota
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"m~o!!v" ""
l"J3 ~ Notary PubfIc - State of FIorIdo
i. '~ear.,liIIo.l~hlgll.2<<D
\~,.. ~i Commllslon # DD346272
"h'* f'-..c:r:-'''-
".....i. Bonded By NatIonal Notary Aasn.
/ FOR CLE
Annual Registration fee: [ V] Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER
, USE ONLY /; ~
, MCR #d n~Rc/} Date Paid q ;;2.~ 'a-I
I
-M\LOBBYIS1\LOBBYIST FORM 04