Delano Hotel
-"""'~
w
to
"-
:IN,
my of Miami Beacl1 Off'1Ce of the City derk
1700 Convention Center Drive, Miami Beach, Fl33139
L08f ,,'st ItEmSl'RA tJoNFORM
Lollbylst m@ans all pl!rsons el'noloyed or .etalned. whether pat.j or not. by a prtnclpal who see\l$ 10 enMUrag~ the passage. defeat
or mOllification of any ordlnall<<, ",!;OUllm. actJt'n or CleCtslon of any comm~Slllner; ;my adlQn. l;letIsIon, recommendatlon or ttle
Oty Man30er or ;my dly boill'd or committee; o' any action. deds1ol1 or n:c;ommendatlon Of ""y dty Jlfll'5Onn<:1 dellned In any
manner In this section, lIurtn!ilhe time period 01 the-entlredeclSlan-maklng process on 5v<:h ilttlOn, cltclSlon or rec:ommendatlon
thet for_bly wUl be heard <lI' r~ by the <lty wmm!SS1M, or a c:lty bOard or COll1ITIII:tee. The wrm $1l2d1Ic:alIy Indudesthe
prlndpal as well as any employee engaged ,,, lobl'lIIng actlvltles. The term "Lobbylcts' has spednc: exclusions- Pl..ace t_
to Ordinance 2004-3435.
~~'L
NAM OF LO g-r:
-=:f'uJ t:nrdtrvro
IlUSINESS NAME AND ADDIliS5
1..-1)(111 1t" M f..q .
(last) (First) (14.1)
tLP. 11-[<{( P.t1ll'iLu (],a., l~ ~r W(Q~. R~l\
(Num1Jel' and Strerl) (Cltv) (stale)' (lip Codc!)
13QS)s3b-11I{o ~~-b&2j<<:.t.l).~
FAX NlIMSEll.. -EMAtI.:
(~) ~h~UI~
TELEPHONE NlII'1BEIl.:
I. LOBBYIST REl'AIMECJ BY:
.J), glJr\ fI") ~ 1lCI.l D j).,c.Hn blalk. '-Pa.rvt.I~
NAME OF PIl.INCIPAl/CUEN.r,-
Jib'X$ ~ t4)~.~~ tu~.
BUSlf'lESS NAME AND ADDRESS (Numbcl' and St_t) (CIty)
,~<;,) I.,l<{-(Pl~ . 80S)~13.0J1U
TELE~HONE NUMBER: FAX NlIMBeR: (OPtional]
R 3~~q
(State] (ZIp Cocle)
EMAIL: (Optional)
Fill out th;. n<<\otllf prlndPlIllsa COl'JlOra\\~, _mtp Ol''TnIsttsec:tion 2-482 tc)l
. NAME OF CHIEF OffICEP.. P,lIRTlIER, OI~8!NEFla"'RV:
U};n ~0fJ-J
IDENTIfY ALL PERSONS lolOLOING, DIF,t!CTLY ORI'~ Y,-A 94 OR'MORE OWNERSHIP INTl!REST IN SUCH
CORPORATION, PA1lT~E1\SHIP OR TP.V;t:
lJ. SPECIFIC LOIB\" ISSUE:
~"1 ~P) un;... U", OJ I 1- ~Jj..:lI51 . 1)\ A . u..o
ISSlN! to be lObbied (Oe5CIllle In ll1ltaU), I]
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A' FuU Name of IndlvltfllallTltI.
I' Ally Financlat, Famlll:II1Il' Profn!lkmalltfiatlonslllll
',"..J'.-.-
~ 0/)0 ra-^ fww.)
- ~r~~'~
t;~~/~:-
8S)-~ EOO/~QO'd L)E-l
9l1l9ESSOH
m3ll SVN3Q~Vj M3J.-I'IOU l'tV ll' 0 l )QOHNJO
I U
.. fh .
IV. DISCLOSURE OF fiRMS AND AMOUNTS OF LOBBYIST COMPENntlON (bISCUlSE WHETHER HOUlIL Y
"LAT IlATE 011 OTHEIl): '
A) L088YIST DISCl.OSURE: (Required) ~O~~
B) PRINCIPAL'S DISCLOSURE (Of LOBBYISl' COMP~NSATtON): (bqulred). 11l1./o.f'D fLU h~, 1 A
Yes ~...:: hlDr~tilla.1 not-fer.'DI'Oflt COtI>"latlon .;'entitvwlthaut SIHH:lal mmaensatlcln.,
~ !!'I_' Pursuallt to Orcllnance i'fo. 2004-3435.
1) Pursuallt to Onlln_ NIt. 2003,,3393 AIllMdiIl!ll MiamI Beach CltV (:ode ChAoler 2 AItJct& VII tlMslon 5
Ib~ Entitled "CamDaiqn Roane(, Reform" V~e~ 1-488 "ntltfed "Prohibited
<:;amoalan Contributions tlv I "hhvl~~mll!lt Iss\u!~:;
~e ~ .:'~==:.::.::r=::,b:'!''7Ge~ds, lItluiDment Dr HI'Vices. or on a Dnlsent
2)
Pursuant to Onlinance No. 1OCI3:.;I;vJS ~ndiOl" Miami Beach atv Code Chant@!' 2 ArtIcle VII Olvislon 5
thereof Entltll\1l..l:jl[Dpillgn F1nilf1C~: Reform", "la The Addition Of~~_S,l:,c.tlon 2-490 Entitled "Prohlblted
R:uIlP.al!llLCpntrlbutions Bv Lobbvifts On Real !'state De~o'p'ro~U~
~.... vOU :::,::~ ~ aDol1cattonfor II DevI!~~Aa~with tMCav.r
aoDliC;lItlDn for chanae of zonln.~ maD deshBlatlon Of' chanGe to the City's Future LInd Use MaD?
Yes
Q
V. SIGNATURE UNDER OATH,
ON OCTOBER 15T OF tAcH YEAR, EActf LOB8Y1sr SHALL SUllMIT TO THE CITY cLERk A SIGNED
StATEMENT UNDER OATH, umNel LOIJ!IYING EXHNDl'FURES, AS WELL AS COMfIENSAnOH
RECEIVED, IN THe ttrY 01' MIAMI tll!ACH FOil THE PRECEDING CALENDAR. YEAR. A srATEMENT
SHALL BE FILED EVEN If THERE HA"E BEEN 1'10 EXPENDITURES ~ COMPENSATION DURING THE
RI:PoktlNG PEIUOD. ~ ~ I.
signature of ~
I do solemnly swear that ell of the fc-regolng facts are true and correct and that I have fl!ad or am
familiar wlth the provisions contained In Section 2-482 of the Miami Beach City Code and all reporting
requirements. ~
Signature of lobbyist: ~_
Signature of Prl"Clpal/~~ . ~
VI. LOBBYIST ID!tfttFtCATlON: PRINCIPAL ID!NTlFtCATlON,
Produced 10
Produced 10
Rlrm of Iclentlflccltlon
~nally known (LobbY~
vn. SIGNATURE AND srAMP Of NOTARY:
Form of IdentIf1catlon
p~~(Prtndpal)
Signature tlf Public Notary - State orlda
Notat~~on ct.&..qbbylst's sign re
~'t>!':~~-- WiIda Montenegro
~.:'~':.~ Commission #DD267008
~\~...;~:~ Expires: Nov 13,2007
~'I~I~'\" Bonded lOrn
Atlantic Bonding Co., Inc.
~~-
ThIs~cIay , 2o.!Ff
Slgl\ilttJr ry _ State~ '::'fT
Notarization of Prindpal's s\9I1lItUre
FOR CLE
Annual Rcglstrabon fcc: [ J Yes [ ] No i.mount d
lobbyist Registration Form received and VIlrlned hy:
Revised 02110/0"1 F: CL
TANIA LEE RAMSAY
MY COMMISSION # DO 186490
EXPIRES: June 1. 2007
8St-~ EOO/EOO d ltE-l
91 I 19E5SQE+
~mll SVN30m M31-l'lOll~ I'IVII:OI tOOH~-lJO