Rosen, Harold / Cafeteria
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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 dedsion 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, dedsion or recommendation
that foreseeably will be heard or reviewed by the dty commission, or a dty board or committee. The tenm specifically indudes the
principal as well as any empioyee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
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(Last)
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(Qty)
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FAX NUMBER:
(State)
(Zip Code)
~~AIL:
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(City)
(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)]
.J NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY: <5v..ea.() Leo\'1av d -
] IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
c..-iE.:9CORPORATION, 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:
A) Full Name of Individual/Title
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B) Any Financial, Familial cSr Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOROTHER): #. ____
A) LOBBYIST DISCLOSURE: (Required) ,;2.";00, j/' /' I q 71/1 ~
B) P NCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ,.;J"lb P
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
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Are YOU lobbyinq on a Dendinq aDDlication for a DeyeloDment Aqreement with the City or
aDDlication for chanqe of zoninq maD desiqnation or chanqe 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, 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 EXPENDITURES OR OMPENSATI 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 'n Section 2-482 of the Miami Beach City Code and all reporting
requirements.
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Signature of Lobbyist:
Signature of Principal/Client: .
VI.
D Produced ID
/ Form of Identification
~rsonally known (Lobbyist)
D Produced ID
Form of Identification
~OnallY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
swor~o and subscrib~p~fore me ~
This :2.., day of \- 00 , 2oCJ"J
>R1 'H n (to ]Ill)
. uQIj)'~ty'u e of Florida
otariza~~~flsi nature
4~ c::.:.. 111312OC1
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State of Florida, County of Miami-Dade
swornr<\~ubscr~ rt>efore me ,y;-'
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Signature of Public Notary - State of Florida
Nota~zation of Prin' , .
LAURA CANO
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: :. '.'1.:, BonCed IIw (
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FOR CLE
Annual Registration fee: [~es [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02{10{04 F: CLER\ALL
ON~R #d7t.S ff/;? Date Paid !) /9, 5/0
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