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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 "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST:
JfJ~ I? it".
(Last)
sletJe^-
(First) L'u ~ -1L
/ ~/.s;:s $D 117 "/"""UC-"~
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TELEPHONE NUMBER:
.::;-~" 971
FAX NUMBER:
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EMAIL:
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I. LOBBYIST RETAINED BY:
p~ ~64-
NAME OF PRINOPAljCL ENT: ~
~ 9~sj?~ 500 ~
(Number and Street)
_~~7~ ~fobf:3
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. ~AME OF CHIEF OF~:- PARTNER, OR BENEFICIARY:
~Eek.-'- 2.0
,
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECfLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, P~TNERSHIP OR TRUST:
/~~~4D1 ~.se.o k(H~, 1n~~~P"Z-O
II. SPECIFIC LOBBY ISSUE:
M~rO\ t~OVl
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
B) Any Financial, Familial or Professional Relationship
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2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Artide VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CI1Y CLERK A SIGNED
STATEMENT UNDER OATH, USllNG 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
REPORllNG 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 contained i ~-482 of the Miami Beach Ci Code and all reporting
requirements. _/ _.. ........__ ...__.._'--
-,._~_._~...-----
Signature of Lobbyist:
.--- --- .---..
Signature of pnndpal/Client: 7 '
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VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
,._....u..u......... "',:>-'-'-:-'-"-:':""-'-"""""~""""''''..---.)
CJ'.E!~nally.kr1owo.(Lohbyist)
VB. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
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State of Florida, County of Miami-DadZ/-
Sworn d subscribed before me
This<- 2'
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Annual Registration fee: [
Lobbyist Registration Form
Revised 02/ 10/04
Yes [ ]No A FO t~a~:R1'~~L~ot73!3~tepaid
ceived and verified :
: LE LL \MARIA-M\LOBBYIST\LOBBYIST FORM 04