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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.
t? e. I L ~ N $O,J L E" >
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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EMAIL:
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LOBBYIST RETAINED BY: ~ 5 c.. I (e.. cur 0 (' !.. /
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NAME OF PRINCIPAljCLIENT:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
,)50 ll<S1'''eJ.;~",
(Number and Street)
~t. / It:>o3, -dtst e..1~ I1A4, p,-- 3 3 ,/-0 r
(City) (State) (Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PAR,TNER, OR BENEFICIARY: ~ -.vt ~ &-1.-, {~S i"t\1 cr / -M t......"-'}.e,-
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: :5 Let<... -t-h-J-....t!..R (..J".- ~;1 A
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SPECIFIC LOBBY I;"UE:
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Issue to be lobbied (Describe in detail):
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II.
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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 COMPENSATION (DISCLOSE WHETHER HOURLY,
/,'LArRA TE OR OTHER). <f 2 /h
A) LOBBYIST DISCLOSURE: (Required) f O() V ,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), 4-tJ,OO / h~
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":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~ Are YOU lobbying on a oending aoolication for a Deyelooment Agreement with the City or
aoolication for change of zoning mao designation or change to the City's Future Land Use
Mao?
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
s~n but, shall not be required to pay any registration fees..
D Yes ~o: Are YOU reoresenting a not-for-orofit mrooration or entity without soecial comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
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 EXPEN TURES COMPENSATION DURING THE
REPORTING 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 in Section 2-48~ the Mi mi Beach City Code and all reporting
requirements. JV' ~ "
Signature ofLobbyist: Jt'A h~ ~
Signature of Principal/Client: {!!!:!!lIV
VI. LOBBYIST IDENTIFICATION: RINCIPAL IDENTIFICATION:
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Form of Identificat n ~;; ~
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Personally known (Lobbyist) ;:i~....~~
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SIGNATURE AND STAMP OF NO I:) ~~~
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[J Produced ID
L Produced ID
Form of Identification
~ersonally known (Principal)
VII.
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 3,I...,.t. day of...~Cl.... .'. 'It' 20 cs-
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/ FOR LERK'S USE
Annual Registration fee: [ ] Yes [ V] No Amount pai1~' .Cl)
Lobbyist Registration Form received and verified by: J.--' )
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc ... .
"EXHIBIT A"
All persons holding, directly or indirectly, a 5% or more ownership interest in such
corporation, partnership or trust are as follows:
1. The South County Trust
Sole trustees: Leslie Schlesinger, Adam Schlesinger
and Jason Schlesinger
Sole beneficiary: Leslie Schlesinger
51%
2. Jason Schlesinger
15.50%
3. Adam Schlesinger
15.50%
4. The Robert Schlesinger Trust
Sole trustee -- Richard Schlesinger
Sole beneficiary -- Robert Schlesinger
15%