Lorraine Mackinney/Arts4Learng
Miami 8I:ad1
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City of Miami eeicii &fi~~ \{fffi-e City Oerk
1700 Convention ~ejt~~~ ~~nl ~5Ch, Fl33139
LOBBY~~'frlt~~~; FORM .
lobbyist means all persons employed or retained, whether paid or not:, by a prit,,~ seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedslon, recommendation of the
Oty Manager or any city board or committee; or any action, decision or R!COO'II1'IeIIdation of any city personnel during the time
period of the entire declslon-making process on such action, decision or recommelldation that foreseeably will be heard or reviewed
by the city commission,or a city board or ...ol,.,ittee. The term specifically includes the prindpal as well as any employee engaged
in lobbying . 11Ie term ......"..... .... specIIk: exdusIonI.. ...... refer tIO 0nIInlIncle 2004-3435.
ft1 ~r;
(Last) (Arst) (M.I)
h~--n~tfi- h,<hp/, Elf?m /4zo WasJjt'~nAve 1h'l2nu '6f;JJtcJ, FL .~3/39'
BUSINESS AND ADDRESS (Number and Street) () (State) (Zip Code)
<341J-~?<~()4J r < qtJ6 -'i:M - Yt~5 /lrJtJcln"~ d/J4'esr/1tWIs 41 ei;
TELEPHONE NUMBER: FAX NUMBER: :
L LOBBYIST RETAINED BY:
IlrIs /..f Learnl 'Y I mId m/
NAME OF PRINOPALlalENT: '
c~~5~576 -/;U~
TELEPHONE NUMBER:
, rL 39/32-
(State) (Zip Code)
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: :r Me... -6. J b.t# I N~
· IDENTIfY All PERSONS HOLDING, DIRECTLY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: fJ ~
D. SPECIFIC LOBBY ISSUE: oJ. .
a f'anb km l1iflfJJt.' lJ.tach 6iltH71i ~ (]g(/ nu~ tlt/JMnlof w,/J#()
~ tope ~ (Desa1~ in detail); I / _ I/'" j I L1' /)~ _.f r _ /. -.-1-.
7ZJ /miJlembnt- IIrffiJri.Rt:I.fml1QS t/er<.YnMr j?mgrtlm /17 -roeuO'luU1CJd~ .
m. drY AGENaES/INDMDUALS TO BE a.08BIED:
A) Full Name of Individual/11tIe
B) Any Financial, Familial or Professional Relationship
.
f1\ ({j..()..v
~.
IV. DISCLOSURE Of TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
nATRATE OR OTHER)
.
A) LOBBYIST DISCLOSURE: (Required) 1 eAU
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~~
The following Information must be answered:
1) Pursuant to Miami Beach aty Code Section 2-488 Entitled "Prohibited Campaign Conbibutlons By lobbyists
On Procurement IssuesH:
o Yes ~ Are YOU IobbvIna on a Dresent or oendlna bid for aoods. eauloment or services. or on a
III'8!!I8nt or oendlna award for aoods. eaulDment or service?
2) Pursuant to Miami Beach City Code 2-490 EntltIed "Prohibited Campaign Conbibutlons By lobbyists On Real
~-_:
DYes . Are YOU Iobbvina on a oendina aooIiadion for a DeveloDment Aa .
aDDIlc:ation for chanae of zonina mao desianation or chanae to u:: ::::-a!:'':
!tJIRl
3) Pursuant to Miami Beach City Code 2-484 (h) Arrf person (except those exempt: from the definition d
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative d a noHor-proflt
corporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or
Indirect, to express support d or opposition to any item, shall register with the derk as required by this
, section but, shall not be required to pay any registration fees..
~ 0 No: Are YOU reoresentina a not-for-orofit CIOI'DOnd:ion or entilv without -w comoensation
V or ,.eimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH ~ EACH LOBBYIST SHALL
STATEMENT UNDER OATH, USTING LOBBYING
RECEIVED, IN THE CITY OF MIAMI BEACH FOR .
SHALL BE FILED EVEN IF THERE M: BEEN
REPORTING PERIOD.
I do solemnly swear that all of
familiar with the i . c
requirements.
J.... Signature of
16.
VI. LOBBYIST IDENTlFlC'ATlON: NaPA! NTlFlC'ATlON:
~ Produced ID ~~ T. ~. t~~ ~'Ut\~O Produced ID
Fonn of Identification MZ50 '52-1~1.f'1 ,1q~-c Form of Identification
o Personally known (Lobbyist) ~11y known (Principal)
State d FJor1cIa, County of Miami-Dade
Sworn and subscribed before me
ThO )l~' 20QS
Signature d Public Notary - State d Florida
Notarization of LobbyIst's signature
Ii) llillna NIIYeml
. . My CommIIIion 00111144
'\- J
State of Florida, County of Miami-Dade or '" Expires AugulIt 01. 2CIOI
Sworn and SUbscri~ before me
This ~day of lJ..Y'e . 200 S
~ )''t~
S1gna1:ufe fA Public Notary - State of Florida
Notarization of Principal's signature
VII. SIGNATURE AND STAMP OF NOTARY:
FORCLEB~~' or-
Annual Registration fee: of...] Yes [ ] No Amount Paid . ~Date .. 10-22
Lobbyist Regislration Form received and verified bY~~ ~
F:\a..ER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM Revised 12{08/04