Michael Larkin / Joseph Blount
...
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
"Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Larkin
(Last)
Michael
(First)
W.
(M.I)
200 S. Biscavne Boulevard. Suite 850
BUSINESS NAME AND ADDRESS (Number and Street)
Miami
(City)
Florida 33131
(State) (Zip Code)
(305) 374-5300
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
(305) 377-6222
FAX NUMBER:
EMAIL:
Joseph W. Blount
NAME OF PRINCIPALjCUENT:
2535 Lake Avenue. Sunset Island No.2. Miami Beach
BUSINESS NAME AND ADDRESS (Number and Street) (City)
Florida 33140
(State) (Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIREcrL Y OR INDIREcrL Y, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Application in connection with Single-Family Residence
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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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $375.00 hourlv
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $375.00 hourly
i y~ N~'::;':..~::.':::~ ~ ~":.i:-~~~~:"" entity w1thll\lt ......,.-1 r.gmoensatlon or
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
Camoaian Contributions Bv Lobbvists On Procurement Issues":
I Yes KNO: Are YOU lobbYinG on a Dresent or aendlnG bid for Goods. eGUIDment or services. or on a Dresent
or DendlnG award for Goods. eaulDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "CamDaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
.3'.<< ~
~Yes J\ No: Are YOU lobbyinG on a aendlnG aDDllcatlon for a DeyeloDment AGreement with the City or
aDDllcatlon for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, UmNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON 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.
~/~
Sig ature of ~bbyist
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 in Section 2-482 of the Miami Beach City Code and all
reporting requirements.
Signature of Lobbyist: ~ 4/ ~
Signature of Principal/Client: e,r- It/ ~~
VI. ", LOBBYIST IDENTIFICAnON: RlNClPAL IDENTIFICAnON:
~oduced 10 ~uced 10
Form of Identification
~rSOnallY known (Lobbyist)
Form of Identification
VII.
SIGNATURE AND STAMP OF NOTARY:
o Personally know'1J,P~qglOR Hatfield
· (~ ; My Commission 00002020
\;o,~~ Expires February 18. 2005
State of Florida, County of Miami-Dade
Sworn to and subscribed before me ^f1,1
This I$r' day of ~~-'.~J.I~ 2ue::r
State of Florida, County of Miami-Dade
Sworn and subscribed before me AU
This /Y day of LJM4 ~-Au , 20b
Ignature of Public No ry - State of Florida
Notarization of Principal's signature
. nature of Public Notary State of Florida
Notarization of Lobbyist's signature
FOR CLERK'S USE ONLY
Annual Registration fee: 6s [] No Amount Paid :;!-5.0 0 MCR # 2-168oVJ Date ~aid '4/ I ()V
Lobbyist Registration Form received and verified by: ~ W J.L-- /~dv..-"~ (<tl.&U
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
1 First Revision - 05-17-02