HomeMy WebLinkAboutAllan T Shulman / The Palms
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, Fl33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal 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
aty Manager or any city board or committee; 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 dty board or committee. The term Specifically includes the
prindpal as well as any employee engaged in lobbying activities. The term -Lobbyists- has specific exduslons. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (AISt) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) I (Zip Code) r
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TELEPHONE NUMBER: FAX NUMBER: EMAIL: J . =tl;7
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LOBBYIST RETAINED BY:
TI+E PAL.-fVl5 ?OU 1l..f 8 el4c-I-I, /N~ .
NAME OF PRINOPAl./CUENT:
BUSINESS NAME AND ADDRESS
30 S ~ 5., '-I ~t)?D ':J-
TELEPHONE NUMBER:
30.:15"" (00//;...1 tlvRU-U-e) H{ol{wti &tLeA[p- '3"3!fO
(Number and Street) (atv) (State) (Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [SectIon 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: (~t'L.s J P fA- d... i ^1 fc y- ILL(, S. c..
IDENTIFY ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~ "'- s J 0 A. d... ; ""\ Ie. (l A- /..L t. ,
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D. SPECFICLOBBYISSUE: e-cn'S-fr....c.:il"", ~ ~,r.,...1 reP<-fJve.o::f-/CSV\ t...--P-
fllA.A-ol: h'gn ~ltti r-e-{Jrz.( Issues 4~4Lt',,! fe-v,rle !J.t~
Issue to be lobbied (Desaibe In detail): ..... . J l.oJ' ~. ,......,. / I.L --'-- /
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III. CITY AGENCES/INDMDUAlS TO BE LOBBIED: - ·
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A) Full Name of Indivldual/ntle
B) Any Flnandal, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBlJVIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) Ph '7c.F/ f 15C;A~ ;J~'=,>/D-0.7~ 7/"Y,:,Ar
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). S ~ ,~bv C
Yes ~ Are YOU reDresentina a not-for-Drofit corDOration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
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1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division S
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaign Contributions By Lobbvists On Procurement Issues":
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2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division S
thereof Entitled "Campaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL 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
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.
Signature of Lobbyist:
Signature of Principal/Client:
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VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION
o Produced ID
o Produced ID
Form of Identification
l Personally known (Lobbyist)
Form of Identification
JIJ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn 1:9. and subscr' ed before me
This 5l"- da oBfl{ 20~
State of Florida, County of Miami-Dade
Sworn and subscribed before me ~ II.
This ~day of , 20~
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""'i,/~.i~,"''''''' Commlssian ~ DD02SQ19
Signature of Pu ic
Notarization f
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Annual Registration fee: [L--J'Yes [ ] No Am
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F. CLER:
;~~N~~ #.2 Z>JS JOate Paid / c! i Df