The Palms South Beach, Inc.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
L.obbyist 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 ULobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
TAc HMt::...S 4L1:::.>tA-N/:)e:.~ .:c .
NAME OF LOBBYIST: (Last).' (First), ..j. (M.!)
AU.-'l-lWf)G-P- I:.'1AaAI'1.ES, (J.A-~ 2. ~"(A."h.t fj,>c~.... ~~vJ../ 2"~o/ 11f/)J.(IIFL:1j'/~1
BUSINESS NAME AND ADDRESS (Number and Street) (City) .. (State) (Zip Code)
30 S-- 3 57J-/&f '/-fJ 3 () ~i>3 57J -/f9o a. i 1-ac.h....,.s <P a.. a /. U-'!
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
-n+6. PA-UH ~ 6 u.. rH- !i &J4-c..I.J. I IN&-.
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS
30 )' - 6"", if 'tJ5lJ5
TELEPHONE NUMBER:
?~JS" 41('~J .t:/v..e.w-i7 /1~WlI' ~I jCl
(Number and Street) (City) (State)
j 3/'/0
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)l
/' I J d eo. d, , "'" ((" /\ a..u , c..
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: -/-t{ jA. >
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY QR INDIRECTLY, A SOto OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: 1f4.,.." , JD 4. d.. , '" k IUU< ,.c.
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Issue to be lobbied (Describe in detail):
SPECIFIC LOBBY ISSUE: . . ~
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CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: ~i..J ~ ~~ I::h Lp
II.
III.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
#-'tor
C~ /4-'H'u ~ J Cd-h ~
J. 10\ I .: I J t-v....A1 ~.. ~ 11, tJ o...v-I s
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
if; 3.:( <;"'
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A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
13 :<5;. L~~
1)
Yes @
2)
Yes @
v.
. I n
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbyists On Procurement Issues":
Are you lobbvino on a present or Dendino bid for Goods. eGuiDment or selVices. or on a Dresent
or oendinG award for GOods. eGUiDment or selVice?
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
Are vou 10bbvinG on a oendinG aDDlication for a Development AGreement with the City or
aPDlication 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, 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. ~ ~
~
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:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
~ersonallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
~rsonallY known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed b me IU-
This ~day of 0 OJ:::J
State of Florida, County of Miami-Dade
~worn tand sUbscri~.:_
. ~ day of k 20~c{.
-~.. .
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
#!' 't'\. Christina Collins
. ~ . My CommIulon OD05t638
~..::I" ExpIres September 23,2005
\MARIA-M\LOBBYISl\LOBBYIST FORM 04