Elaine Parker 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, derision 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 spedflcally includes the principal as well as any employee engaged
in lobbying activities. The term ~Lobbyists" has specific exclusions, Please refer to Ordinance 2004-3435,
Parker Elaine
NAMEOFLOBBYIST: (Last) (First) (M.I)
MIFF / MDCF 300 NE 2 Ave 5th Floor Miami. FL, 33132
BUSINESS NAME AND ADDRESS
30.5.237.3456
TELEPHONE NUMBER:
(Number and Street) (City)
305. 237. 7344
FAX NUMBER:
(State) (Zip Code)
e laine~miamif ilmf e s t ival. com
EMAIL:
LOBBYIST RETAINED BY:
N/A- Same as above
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (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)]
· 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:
SPECIFIC LOBBY ISSUE:
VCA Cultural Tourism Grant
Issue to be lobbied (Describe in detail):
III. ~ AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
VCA Grant Board
(do not know individuals)
ZV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATZON (DZSCLOSE WHETHER HOURL Y~
FLAT RATE OR OTHER~,,
A) LOBBYIST DISCLOSURE: (Required) NON PROFIT
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). NON PROFIT
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":
[] Yes .~. NO: Are you Iobbvinq on a oresent or oendinq bid for aoods, eauioment or servi~e~ or on a
oresent or oendina award for aoods, en_,_,ioment or service?
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
[]Yes .~No:
Are you Iobbvina on a nendina aunlication for a Develonment Aareement with the City c--
aonlication for chanae of zonina man desianation or chanae to the City's Future La.d
MaD?
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
section but, shall not be required to pay any registration fees..
y Yes [] No: Are you renresentina a not-for-nrofit cornoration or entity without snecial comoensatiplt
or reimbursement..
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYZST SHALL SUBMZT TO THE cTrY CLERK A SZGNED
STATEMENT UNDER OATH, LZSTZNG LOBBYZNG EXPEND1rTURES, AS WELL AS COMPENSATZON
RECEZVED, IN THE CZTY OF MZAM! BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEMENT
SHALL BE FZLED EVEN [F THERE HAVE BEEN NO EXPENDZTURES OR COMPENSATZON DURZNG THE
REPORTZNG PERZOD.
Signature of Lobbyist Elaine Parker
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiarrequirements.With the provisions co~~ami. Beach City Code and all reporting
Signature of Lobbyist:
Signature of Principal/Client: (same)
VZ. LOBBYZST ZDENTZFZCATZON:
PRZNCZPAL ZDENTZFZCA'rZON:
[] Produced ID
Form of Identification
w~ ~X] Personally known (Lobbyist)
~. S[GNATURE AND STAMP OF NOTARY:
te of Florida, County of Miami-Dade
om to and subscribed before me
] ~,,~ [~nnual Registration fee: [ ] Yes [1 ~ A
[] Produced ID
Form of Identification
[] Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of ,20__
Signature of Public Notary - State of Florida
Notarization of Principal's signature
. FOR CLERK'SJJSE ONLY
fee: [ ] Yes [ , ~ Amount F~ai~l, /-~ MCR #
Registration Form received affa verified by:
Date Paid
Revised 12/08/04