Juan Carlos Toca / Altos Del Ma
OCT-01-2004 17:07
CITY MIAMI BCH CLERK DEPT
305 6737254
P.04
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST lU!.GISTRATION FORM
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Lobbyist me~ns all peISOllS ernplclyed or retal"ed, whether p~ld Dr not, by a prlndpal who seeks to encourage the paliSage, der~al
Dr modification Dr any ordinance, Rlsolutlon, actio" or decfslon of i1ny eommlssiol'lef; ~ny action, decision, recomJ\'lel'l~tion of the
CitY Manager or any city boilJ'd Dr committee; or any actign, dedslon or Rlcommendaoon of any city pl!r1Onnel defined in any
IT1iII1ner In this 5edion, during the time period of tile entire declslon'milking pl'OCe5S on such action, detlslon or recommendation
mat fllreseeably WIll be heard or rl!Vlewed by the city commission, Dr a dty board or committee, The term spedf\Cll11y includes the
prIndpal as well as any employee rmgaged iolohbylng ac\jyitie5. The term .lobbyl.ts" has spedrill: Pduslan.. PIeiIH ""fer
to Orcllnance ZOO4-J435. \
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NAME OF L08BYIST: (I..a~t) ~(M.I)
A.
FAX NUI'I9ER:
J. L088YIST RETAINED IIV:
fM~pg-~ qp.
NAME'O PRINCIPAL/CLIENT:
J\~~ba..~ L.TD. ~eo\\J ~CbT'I-\-1~\If[. 331.44. <d)rT~QQb
BUSI..eSS NAME AND ADDRESS (t4umtH!r and Street) (Oty) (Slate) (lip Code)
~12.!P2~U5?;i~ ~~?~\fJO:' ~ ~
TELEPH E NUMBER: FAX NUM R: (Optionill) EMAlL; (Optlollill)
FIll ~t bill RCtlon If prtnciPillls a torpar.uon, Pa""el1lhlp ar TAm [5KtIan 2.482 (en
. NAME Of C:HIEF OFACER.. PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTl.Y OR INDIRECTLY, '" 5% OR MORE OWNERSHIP INTEII.ESTtN SUCH
CORPORAnON, PARTNERSHIP OR. TRUST:
:B fiPFCtflC ~y !SSUI;
riDS ue \ H Ch"
Issue to be lobbied (Des<:IItH! in detail);
~ 0,"", ........Un :~
m, OTY AGENCES/INOMDUAlS TO II! UIII8IED:
"' filII NIIIIHI of indIVIdual/me
B) Any flnanelel, Familial or ~feulonalll.latlaMhip
en:: crt-1.u.\n l
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OCT-01-2004 17:07
CITY MIAMI BCH CLERK DEPT
305 6737254
P.05
'"
~ IV. DISCLOSURE Of Tt~MS AND AfoIOUNTS OF L088Y1S1' tQMPENSAnoN [DISCLOSE WHmtER HOURl Y,
FI.AT RATE OR OTHfp.): ~
. II) LQBBYlST DJSCLOSUIl.E: (Required) ~t:l:Sf ~ ~ .~.
, IPAL'S D1S0.0SURE (OF LOBBYIST cbMPEN~I\TlON): (1l..,lred). ~ ~~OCO. .
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to Pursuant to Ordinance No. 2004-3435.
1) Pursuant tQ Ordinanct! Na. 2003-3393 AmendinCl Miami Beach CIty COde O1aoter 2. Artide VII Division S
Thel'P.O( Entitled "Camoaian Anance Reform" 'VICI The Addition Of Code 5ectipn 2-488 Entitled 'Prohibited
Campaign f.ontributions ay Lcbllylsts On Prnn.Jl'l'n1@fIt Issues::.
YM E~re ltou Iabbvina on a Drese~;:; q~lIIdlna ~:~~ _uioment or seNi-.. Or on iI Dre5ent
or DBnCIlna awwd for goods,. eouiament or seMm?
2)
Pursuant to OnftnBlICII! No, 1003-3395 AmendlnCl Miami Beach C:itv COde ChaDter 2. ArtIde VII DMsion 5
thereof Entl~1!d "campaign Finance Reform" Vi;, 1Jle Addition Of Code section 2-490 Entitled "Prohibited
Camoalon Covtributions BY Lgtlbyists On Real E!b.te OW@Iopment I!i5U~':
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V.
SlGNAlUU UNDER OATtt:
~ OCTOBER. 1ST Of EAOI YEAR,. EACH LOBBYIST SHALL SUBMIT 1'0 THE CITY CURK A SIGNED
ST41'EMENT UNDER OATH, Um~G LOBBYING EXPENDITURES, AS WEll AS COMPENSATION
IU'CEIVeD, IN THE ClTY OF MIAMI BEAOi FOR THE PRECEDING CAlENDAR YEAR. ,. STATEMENT
SHALL BE FILED EVEN IF THERI!. HAVE BEEN NO EXPENDITURES Oil COMPENSATION DURING THE
UPORTINGPERIOD. C.. .~ ~
SigluMe af 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 Oty Code and all reporting
r~ulrements, C ~ -kt-l- G.t1A-.. 1
Signature of Lobbyist: ~ ~ .
Signature of Principal/Client:
VI.
L08BYlSTtDEN11FICA11ON:
P1UNCI"AL IDEN11FJCAnON:
Produced 10
Produced ID
Fonn of IdentifitiJtlon
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
~
State of Florida, County of Miami-Dade
~orn to svb$c:rIbed me me .j
This da of 20~7
state Df florida, COunty of Miami.Dade
SWorn and SUbSO'I~ me
This~daVd.. I~
Signature of PubliC Notary - State of Flofiaa
Notarizatlon of Prlnclpafs signature
SIgnature of Public Notary - State of Aorida
Hotarlzatlon of Lobbyist's Signature
OFF! IAL~rmt~YSEAL
L:iV:::\
NOI'ARYPUrU': ~'7;i'-, C~ RD::IDA
COMMlSS~O;JT~a. C~~l=Z:>:J
MY COMMISSIQI EXP. MAR. 2S )Cr,S
SEONLY I J
MeRIt 2 7,2 ~ time Paid ) c; ~ 'iJ tj
IA.",\LOBBYISl\LOBBYIST I'ORM o~
, ;.
FOR
/lI'lnual Rl!glstrallon fee: [\. ItS [ ] Na Amount
t:ollbVln R.egistman FI)nI1 rel:elved and verine<! by:
Rl!Ylsed OZ/10l04 F: CU
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TOTAL P.05