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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON FORM
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 term specifically includes the
principal as well as any employee engaged in lobbying activities. The term "LobbyistsR has specific exclusions. Please refer
to Ordinance 2004-3435.
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LOR..I- ANN
(Last)
IN1et,NA-rIONA:L
(M.I)
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NAME OF LOBBYIST:
t=1.O~ DA.
02-7 -0 ~ 11
TELEPHONE NUMBER:
BUSINESS NAME AND ADDRESS
Q(h
FAX NUMBER:
I. LOBBYIST RETAINED BY:
F1.OI!-tDA 11\l~A:1l0~ UN I Vee51 T{
NAME OF PRINCIPAl/CLIENT:
H20D ~ B1+l
BUSINESS NAME AND ADDRESS
trr eeer
(Number and Street)
Hll\N\
(City)
F-L-
(State)
33lq
(Zip Cod
o() S 2:i \ ~ - 2-000
TELEPHONE NUMBER: FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
-+\0\.,01\f-t:) (<.... U Pr-1 A:r--l
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
~1J\T~ VN'~t1""'-(
.
II. SPECIFIC LOBBY ISSUE:
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ProD Peb-~n\J~ V~ bR-I\:::r--JT
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Famlllal or Professional Relationship
CAii (Y ti '-Al'-f f ~ VC-/\ NJA;-
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): (Required).
ion or
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaign Contributions By Lobbyists On Procurement Issues":
Yes
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions Bv Lobbyists On Real Estate Development Issues":
Yes
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 PRECEDIN CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX DITU S R COMPENSATlO 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 contai 'n Se 0 2-48 of th i . Beach City Code and all reporting
requirements.
Signature of Lobbyist:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
~~~~(~bb~'j;)--:::.:>
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn 0 and subscribed before me
Th' da ofNov(t~r, 2004
i\)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Aorida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\MARIA-M\lOBBYIST\LOBBYIST FORM 04
NOV-05-2004 14:07
3056241402 P.83/03
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DX CL~l: WMJ::lnr:J\ nvlol.....',
FLA T RA TE OR. OTHER):
A) LOBBYlST DISCLOSURE: (Required)
N01
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Requlr
r
1)
Pursuant to Ordinance No. 2003-3393 AmendlnCl Miami Beach City Code Chaoter 2. Article VII, DivisioQS
l11ere;of Entitled "Ca/JlO(;lign Finance RefQt:m:Y!.a...!:M.AdditiOIJ Of Code Section 2-488 Entitled "Prohibit~
Camoalan CDntribu~ions By Lobbvlsts On Procureme.Dt Issues":
nt
2) Pu~uant to Ordinance No. 2003-3395 Amending Miami Beach aty Code C/1aDter 2. Article VII Divis{OfLS
thereof Entitled "Camoaion Einance Reform". Via The Addition Of Code Section 2-490 Entitled "Pr~
Camoaign Contrit>l1tion~ Bv LobbYists On Real Estat~ 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, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDIN CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX DlTU S R COMPENSATlO DURING THE
REPORTING PERIOD. . ~
d correct and that I have read or am
I 'Beaeh City Code and all reporting
Signature of Prinel
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced 10
Produced 10
Form of Identification
Form of Identification
~nall!,-~principal)
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of MIami-Dade
Sworn to and subscribed before me
This day of . 20_
State of florIda, County of Miami-Dade
Sworn and subscribed before me h J
This ~day of fl.tdhJ{b.~. 20b-
LttL Q. /lZL~
SIgnature Public Notary - State of Florida
Notarization of Principal's signature
Signature of Public Notary - State of Flortda
Notarization of Lobbyist's signature
e JUOIlHA. MIIQ81.
". . MY COtll11UlON *. to..- .
. Ql!IE8:~.- '
l~ARY R.t<<llIIy.....&~..
/ FOR CLERK'S USE ONLY
Annual Reglstratlon fee: [ ) yes [./) No Amount Paid MeR # - Date Paid
Lobbyist R.egistratlon Form received and verified by:
Re"iSQ(j 02/10{tX F: CLER\AL -M\L.OeBVISl\LOBBYIST FORM 0'1
TOTAL P.03