Agnes Youngbood/Concert Assoc
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REC I\lED
City of Miami Beach Office of the City Clerk
1700 06rUllinti<bn ~em:e26>rive, Miami Beach, FL 33139
CITY CtoiBY-i~~STRATION 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 dty board or committee; or any action, decision or recommendation of any dty personnel defined in any
manner In this section, 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 dty commission, or a dty board or committee. The term specifically indudes the
prindpal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435. '
, :~. Youngblood
,
NAME OF LOBBYIST:
Community Concert
BUSINESS NAME AND ADDRESS
Aqnes
(Last)
Association, Inc.
(Number and Street)
(First)
2333 Brickell Ave.
(aty) (State)
(M.I)
#417 Miami 33129
(Zip Code)
305-858-5016
TELEPHONE NUMBER:
younqaqnes@bellsouth.net
FAX NUMBER: EMAlL:
I. LOBBYIST RETAINED BY:
Agnes Xoungblood.
NAME OF PRlNaPAl/CUENT:
Community Concert Association, Inc. 2333 Brickell Ave, #417 Miami, 33129
BUSINESS NAME AND ADDRESS
305-858-5016
TELEPHONE NUMBER:
(Number and Street)
(aty)
(State)
(Zip Code)
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFlOARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
~~~nmm~nn ~~~~nn of Th~rl~rp nn Mi~m; Rprich
Issue to be lobbied (Desaibe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
Cultural Affairs Council
none
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
no compensation
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
no compensation
1)
2)
Pursuant to Ordinance No. 2003-3395 AmendinQ Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbvists On Real Estate Develooment Issues":
Are ~oy !ob!lyino pn a Dendino :D~IIGltiO~ for ~ Develoomen~,:,,;:,:: W~h ~ c~ :r
aDDhcatlon for chanGe of zoninG maD deSIGnatIon or change 0 hI' Fu ur n U e MaD?
DYes ~o:
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 COMPENSATION DURING THE
REPORTING PERIOD.
~ r'
.. ' . S; no,"", of "'bb~st
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 reporting
requirements.
VI.
LOBBYIST IDENTIFICATION:
---~
Signature of Lobbyist:
Signature of Principal/Client:
PRINCIPAL IDENTIFICATION:
o Produced 10
o Produced 10
Form of Identification
Form of Identification
~. Personally known (Lobbyist)
'Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
N~- ~ r.\ FOR CLERK'S USE ONLY \~ '--l"i::r&'('C . +rl/~
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # J~~'t"''''''''bate Paid ~
Lobbyist Registration Form received and verified b~ ~ C')~
Revised 02/10/04 . R\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04