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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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER:
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(State) (Zip Code)
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E~IL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPALjCUENT: '
J./'A. J1AR" If.-~neyh''J. &L.C.
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(Number and Street) (City)
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FAX NUMBER: (Optional)
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(State)
.131-g1
(Zip Code)
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TELEPHONE NUMBER:
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: If r jJqttl l1t.tUl'u)"4vJ
. IDENTIFY ALL PERSONS HOLDING, DIRECfL Y OR INDIRECfL Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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A) Full Name of~ndividual/Title
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B) Any Financial, Familial or Profession~el~nslllP7
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) 4{ ~ -,0() 0 ."" J'Vo>ItJ
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). /I j~ "po.-.> ~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues";
D Yes ~ No: Are YOU lobbying on a Dresent or Dending bid for goods. :uiDment or services. or on a
Dresent or Dending award for goods. eguiDment or servi ?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~'NO: Are ~ou ~obbYing on a Dendin? aDDlicatio~ for ~ Devel~::::~ A:r:~7~": v:::~ ~he ~~ ~:
aDDhcatlon for change of zoning maD deSignation or c 0 h 'F r La U
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3)
Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be reqUired to pay any registration fees..
D Yes ~No: Are YOU reDresenting a not-for-Drofit corooration or entity without sDecial comDensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO T
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE HCEDI G CALEN
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP N UR 0 CO
REPORTING PERIOD. \
Sign ur of Lobbyist
I do solemnly swear that a of the fOregOia are true and correct and that I have read or am
fami~iar with the provisions c ntain d i ,set~2~ of the Miami Beach City Code and all reporting
requirements. \' ;>I,
Signature of Lobbyist: . \.'--- "'----
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATIO
PRINCIPAL IDENTIFICATION:
FO
Annual Registration fee: [ ] Yes [ ] No Amou
Lobbyist Registration Form received and verified by:
F: \CLER\$ALL \MARIA.M\Lobbyist\LOBBYIST fORM
I'; Produced ID I~roduced ID CA
Form of Id~~ti5>alJn. Sommer Form of Identification
~ Personally known (LObbViStt,Y J My CclmmiMion D022t4~rsonally known (PrinCipal)
Of" ExplresJune11.2007 ~, Came Somlll8f
VII. SIGNATURE AND STAMP OF NOTARY: ;'''Y') My CommIalon DD2218,14
". Of" expires June 11, 2007
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This oK day of , 20~J
Revised 12/08/04