Euramerican Group 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 seelLs to encourage the passage, defeat
or modification of any ordinance, resolution, action or derision 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 engageff
in lobbying activities. The term 'Lobbyists' has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF L(~BBYIST: (Last) (First) (M.I)
BUSINESS NAME AND AD'DRESS
TELEPHONE NUMBER:
(Numbem~ and Street) (Oty) (State) (Zip Code)
FAX NUMBER: / EMAIL.~'
I. LOBBYIST RETAINED BY:
NAME OF PRIN~PA~C~E~:
BUSINESS NAME AND ADDRESS k~lumber and Street) (City)
TELEPHONE NUMBER:
(State)
FAX NUMBER: (Optional)
(Zip Code)
EMAIL: (Optional)
Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECZFZC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
cTrY AGENCIES/INDIViDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional RelaUonship
[6~ 0S X~/X~] 90:0I ~H~ ~0/~0/90
DX~(~LOSUI~ OF TERMS AND AMOUNTS OF LOBBYIST COIqPENSAT/ON (DZSCLOSE WH~HER ffO~ ~
F~T RATE OR O~ER~
The following info~a~on must ~ an~er~:
~Yes
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyist~
On Procurement
r Yes'~(~No: Are you Iobbyinq on a present or pendinq bid for
qoods,
e~uiDn~nt
or. se~vices~
,or
on
q
/,
present or 0_endinq award for qoods, eauiDment or service?
2) Pursuant: to Miami Beach City Code 2-490 Entitled ~Prehibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
'r~qo: Are you lobbying on a I~endin.q a~_-,_qca.tion for_a De_veloDment A~r=c~ent with the City
/ ' aDDlicaUon for change of.zoninn maD_desienation or C~taflqe tO the City's Future Land
Map~
3) Pursuant tO Miami Beach City Code 2-484 (h) Any person (except those exempt from thc 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
section bull shall not be required to pay any regi~ration fees,.
~ Yes',l~LNo: Are you represerrtinq a not-for-profit
co rlloratio ri. or_ enUttr_wl.'.tho, ut~Decia I
or reimbursement_ .
V. SIGNATURE UNDER OATH;
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYL~T SHALL SUBMIT TO THE CLTY CLERK A S~GNED
STATEMENT UNDER OATH, LTb'T~NG LOBBYING EXPENDZTURES, AS WELL AS COf4PENSAT~ON
RECE/VED~ %N THE CllY OF MLa~N! BEACH FOR THE PRECEDTNG CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN iF THERE HAVE BEEN NO EXPEND/TURE$ OR COMPENSATION DURTNG THE
REPO RI-ING PER)EOD.
! do solemnly swear that all of the foregoing facts are true and correct and that T have read or am
familiar with :he provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Principa!/Client;: _ -. ____
VI. LOBBYIST I'DENTZFZCAT~ON: PRZNC[PAL ZDENT~FZCATZON:
Ii Produced ID
Form of IdenMfication
yfi Personally known (Lobbyist)
V'~. S%GNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Da~e
PrOduced ID
Form of Identification
.~ersonally known (Principal)
State of Flodda, County of Miami-Dade
Sworn to and subscribed before me ~. Swore add subscribed before me --
This ~. ~,4 day of~ 20Z~ This~;~day of ~ 20~5
?.
~ 'g ~r~bli~~~d~ Signa~re of Fublic NoOn'or Florida
O~yls[ g~lS~fion Porto r~iv~ and verified by: ,.. f r~ /'-J l
F:~CLER~$ALL~A~A-~L~byI~LOBB~ ~RM 05.~ ~ Rev~ JZ/08/~ ~
~t~:~O c;O ~0 uric