James Rauh/Mint Entertainment
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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 prindpal 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, dedsion or recommendation
that foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term specifically includes the
principal as well as any employee engaged in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435. .
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NAME OF LOBBYIST: (last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (aty)
865) 5"<V-t.{7~7 ti~)5~r--55C'l
TELEPHONE NUMBER: FAX NUMBER:
/Ii1 14"" I 1!Je'"4C If-
(State)
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(M.!)
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(Zip Code)
EMAlL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINOPAL/CUENT:
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BUSINESS NAME AND ADDRESS
4"'- , A/~ I (Je-~ Fe
(Number and Street) (aty)
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(State) .
(~p Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
· NAME OF CHIEF OFACER, PARTNER, OR BENEAOARY: 12c k..\.e {4t~ ~
· IDENTIFY All PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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l'NOt ~IINK
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A) Full Name of Individual/Title B}AnYF"'~~milial or Professional Relationship
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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 COMPENSATION DURING THE
REPORTING PERIOD. ~ ~
nature of ~
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 reportin
requirements.
Xsignature of Lobbyist:
I- Signature of Principal/Client:
[J Yes ~o:
2)
oYes ~o:
V.
VI.
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY LobbYists On Procurement Issues":
Are YOU lobbyina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaiqn Contributions By Lobbyists On Real Estate Develooment Issues":
Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment AGreement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
--
o Produced ID
~ Form of Identification
~onallY known (Lobbyist)
o Produced ID
Form of Identification
~nallY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to an sUbscribe~fore me
This ay of ~ 201'
0..
State of Florida, County of Miami-Dade
Sworn and subscribed before me _
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Signat~re ~f Public Notary - St~te of Florida ..,. ........ ...........*gOf Public No~_- ~tate of Florida
Notarization of LobbYISt's slgnatu "'LAURA cANO Notaraz t n of Prm.cliiiJ:SsnmatuU. re..' ...-----..-..
eomm# 000260\ \\ lIL1:MEN I E"DIMURO
. . ~"''''"''''~,!- :;:.ires 1/1312008 NOTARY PUBLIC - STATE OF FLORIDA
CLEMENTE 01 ., . .:"; Bond lhN (800=~ COMMISSION # DO 049791
NOTARY - STAT I,,, IDAr.;~. ~~.~~~~.... MY COMMISSION EXPIRES AUG 13 2005
. . COMMI "'m~r""". . ,
MY SION EXPIRES A . 3, 2005
FOR CLE
Annual Registration fee:M Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\AlL\MARIA-M\lOBBYIST\lOBBYIST FORM 04
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