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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION 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 "LobbyistsW has spedfic exclusions. Please refer
to Ordinance 2004-3435. c:..-=-_\
CHALtBvg. MAlVA
NAME OF LOBBYIST: (Last) (First)
:n.l)/ 5. 8,A}":5l-/c.l!e p~" St.llr6 .3oc::) M/AHI
BUSINESS NAME AND ADDRESS (Number and Street) (City)
~(){5- l!>5+' ~e2.:z... .iJOS-a54. 2e~o
TELEPHONE NUMBER: FAX NUMBER:
11.
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(M.I)
.:!!1fJ 13 ~
(State) (Zip Code)
p}Ghc;111lJb{i6rHr-ch~cJb. CtlM1
V' EMAIL:
I. LOBBYIST RETAINED BY:
5(;~6HcI2eP~~"'Ies,INC Pot) . roC/X ~/5d 1/8'/YrN"~ N.:!:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ,
de,/;to(6:t
(Zip Code)
(~)4B'f ~111~
TELEPHONE NUMBER:
FAX NUM,BER: (Optional) .
EMAlL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
/ft'J/V 11- Ib~ €CII-fe.-U
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: /hvtvA- 6 €72A~2 cA7e..-U
eF JjL) /6 Tc~ 67U ~Af-'V-M
n. SPECIFIC LOBBY ISSUE:
~rlFlC.d"'1!J dP ,API'~te/A reues-s fffJP! PeJ.lIJJ,/rteJAJ I)" ~1Jt,I/qvlt& liK:.ATl5l/ ~~ft
Issue to be lobbied (Describe in detail):
In. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
JI .Q
A) LOBBYIST DISCLOSURE: (Required) r/XsP Pt!1!;1.N flee IDjt .!Sa.! d.:?.:?
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). eam~ ,pC ~e..
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach CitY Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaign Contributions Bv Lobbyists On Procurement Issues":
Yes e
Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGUiDment or services. or on a Dresent
or oendinG award for Goods. eGUiDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendlna Miami Beach City Code Chaoter 2, Article VII Division 5
tbereof Entitled "Campaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists Qn Real Estate Develooment Issues":
,,' . ..' .; .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST. OF E~C"'YEAR, EACH LOBBYIST SHALL SUEiMIT TO TttEdrY' CLERic:~ SI~NED
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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I .do solemnly swear ttiat 'all' of ttie'for.egoing facts . are tr'ueand correct and that! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
S;go,""" oflob"I"" ~
Signature of Principal/Client: ' ...~
VI. .
LOBBYIST IDENTIFICATION:
Produced 10 FLo Ie I f).,4. p~ J V~
Fonn of Identification
PRINCIPAL IDENTIFICATION:
Ll ~ced 10 -rhtL; jllDr' oj M ~ Li ~"",J ~
Fonn of Identification '
Personally known (Lobbyist)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State oUlocida; County Qf f'Jiiamr-Oade . .
Sworn to and subscribed before me
This ~ day of O.t. '+
:', '., ..'
~0fIS"~ rU-1APf,c-_
. S41te bf~,..C:OUhty (!If-Midi.!i &de.. .' '.:.
Sworn and subscribed before me
This ay of Ah,,,,,,,j,_. 20.e.Y
€~
Annual Registration fee: ~o A oun
Lobbyist Registration Form received and verified by.
Revised 02/10{04 F LER A
Sig ture of Public Notary State Of r1ericla N.u.J
Notarization of Princ.!Pal'~~ig!l
. YVONNE RAVvSON ..
. 'Notary -r-fu"lj"c.. New.'Je'rsey
. ...~ .Atlai"itit 'County. '.. .
My Commission Expires Sept. 10, 2008
,.."
JOSE BARDIN JR
NOTARY PUBUC STATE OF FLORIDA
COMMISSION NO. DD1I788S
MY COMMISSION EXP. MAY 14,2006
t .:..
N;cit.;2.738n Date Paid