Robbins Kent/Roney Palace Condo
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City of Miami Beach Office of the City CierI<
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REG1STRA nON FORM
lobbyist means all persons employed or retained, whether paid or not, I)y a principal wtlo seekS to encouragll Ill'" 1J<I.:Mlge, defe~t
or modiflcallon cA any ordinance, resolution, action or dedsion of any commissioner; any action, decision, recommendation of the
aty 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 pl'OCl!SS on SUCh actIlm, L1",;I,,;ull 01 re<:ommend"tion that forCSl'cilbly will be heard Dr nw!<lwGd
by the dty commission, or a city bean:! or committee, The term specifically indudes the principal as well as any employee eng;Jged
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NAMIO OF LORRYT!rr~' (last) (First)
,\Ii,
(Number an et) (atv)
'05...5'3/...015
FAX NUMBER:
(MJ)
'l. 33/31
(Zip Code;
~OlJth .nef
TE~EP\040NE NuM~R:
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NAMF OF PRy PALJCUEN1":
"1301 Ccllms AlleII~MWIlI &c.~ {L 33/32
BUSXNESS NAME AND ADDRESS (Number and s) (CIty) } (Sllll~) (ZIp Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
I:MAlL: (Optlonal)
Fill out this section If prinCipal is a corporatiOn, t>armerShlp or Trust [Section 2-482 (IO)]
. NAME OF CHIEF OFFICf3'ARTN' OR BENEFICIARY:
. ~~;tl\P~o~s Ho9J:, D'X.lrL~ f[g~~~~o OR MORE OWNERSHIP INTEREST' IN SuCH
COItI'ORATION, MI\TNERSHIP OR TRUST:
m. t:1TY AG&NCIES/INDMDUALS TO BE LOBBIED:
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B) Any Financial, Famlll:!Id or profeuional ~onsIIlP m
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II.
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A) Full Name of Individual/ntle
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IV. DISCLOSURE OF TERM-UND AMOUNTS OF LOBBYIST (:DMPENSATION LWSCLOSE WHETHER HOURL Y,
FLAT RA TE DR OTHER) ~
A) LOBBYIST OISa..OSURE: (ReqUlred)~'" 000 c.;
15) PRINCIPAL'S DISCLO:::UI\E (OF LOBBYIST COMPENSATION): (Requir.r1).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled ~Prohiblted Campaign Contributions By Lobbyists
On Procurement Issues":
[1 Yes ~o: Are YOU Iobbvlna on a Dresent or oendlnG bid for GOOds. eaJ.liDment or 5el"Vices. or on a
oresent or uendinG award for GOods. eGulDment or service?
2) pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development IssuesH:
IJYes ..INO: Are you lobbyinG on II pendinG lIoDlication for II Develoument AGreement with the Cltv or
3DDlit'.Atinn far chlIlUIP. of :l!anino maD desillnaJ;ion or chanae to the Ow's future Land Use
M.u1
3) Purouant to Miami Beach LIty Code 2-484 (h) Any person (except those exempt from the definition of
~lobbyistH as set forth In Section 2-481 above) who only appears as a representative of a not-fur-profit
corporation or entity without Spedal compensation or reimbursement for the appearance, whether direct, or
indirect, to exprE::l$ $UPPort Of or opposition to any item, shall ~i51:p.r with the c:Ierk as required bY this
section but, shall not be required to pay any registration fees.,
~ 0 NO: AI'8 vou representing a not-fvl:-lJrolit mrPOnltion or entity without sDccilll comllensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1S!: OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLfRl<: A SIGNED
STATEMENT UND~R OATH, LISTlNG LOBBYING exPtNUITURI:5, AS weLL AS COMPl!:NSATION
RECEIVED, IN THE CITY OF MIAMI B~ACH FOR THE P CEDING CALENDAR YEA ATEMENT
SHALL BE RLED EVEN IF THERE HAVE B~EN N P DITURE 0 COMPEN RING THE
REPORTING PERIOD.
LOBBYIST IDENTIFlCA
and correct and that I have read or am
I Beach City Code and all reporting
T no solemnly swear that all of
famillar with the provisions co
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
PIUNCIPAL IDENTIFlCAnON:
o Produced ID
(l Produced 10
Form of Identification
Form of Identification
~nal1y known (Lobbyist)
YD. 5IGNATURe AND STAMP OF NOTARY:
.' FOR CLERl<:'
Annual RoglW<ltion fee: {~.-{ Yes [ ] No Amount Paid
lobbyist Registration Form received and verified by:
F:\a.ER\$ALL\MARIA-M\Lobbyist\LOBBYlST fORM 05.doc
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Revised 12/08/04