HomeMy WebLinkAboutBetty Ferrero / Council Latin
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON )o'ORM
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 tenn specifically includes the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordi nce 2004-3435.
(Number and Street) (City)
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FAX NUMBER:
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY: ,_ [.~ ,
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NAME OF PRINClPAl./CLIEN
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (St e) (Zip Code) :s ::'31 "{
05Y +b5:u' (
TELEPHONE NUMBER:
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ -'L ~ ~~ ~~n0
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: --=&. ~~ c:. . ~ ~e.'b
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
8) Any Financial, Familial or Professional RelationshiPl
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL:S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chapter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaian Contributions By Lobbyists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2, Article VII Division 5
tbereof Entitled "Camoaign Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaian Contributions Bv Lobbyists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY 'CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEA.CH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO ENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. "
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 contain . Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Personally known (Lobbyist)
Signature of Lobbyist:
VI. LOBBYIST IDENTIFICATION:
Produced 10 F(;,.C:-{"') .0 R'3 ' S1:,. 91/- D
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY:
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Signa ure of Public Notary - State of Florida
Notarization of Principal's signature
/ FOR CLERK'S
Annual Registration fee: [ ) Yes [ (....o1'No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\
Date Paid
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