Tommaney, James/A. Youngblood
M:om. Il... Atl1
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City of Miamt"1i~~}h~ ~f the aty Clerk
1700 Conventiontff~r .qri~ rtic06 Beach, FL 33139
LOBBPf~ ~~~~tCioRM
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, declslon, recommendation of the
City Manager or any city 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 recommenclatlon
that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specifically Indudes the
princll>'l as well as any employee engaged in lobbying activities. The term "LobbyIsts- has specific exclusions. Pi.... rtIfer
to Ordinance 2004-3435. .
To~maney James J
NAME OF LOBBYIST: (Last)
(First)
(M,I)
EDGE Theatre 2811 Somerbet Dr. #104 Laud. Lakes FL 33311
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
954-733-e735 954-731-4986 edgetheatre@earthlink.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
(Zip Code)
I. LOBBYIST RETAINED BY:
Agnes Youngblood
NAME OF PRINQPAL/CUENT:
Community Concert Association, Inc. 2333 Brickell Ave/ #417 Miami33129
BUSINESS NAME AND ADDRESS
305-858-5016
TELEPHONE NUMBER:
(Number and Street)
(City)
(State)
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out tt1i1l1f1Ct1on If prindPIII ... Corporation, ...rtn.....1p or Trust [Section 2-482 (e)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY All PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUOi
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Recommend Season of Theatre on Miami Beach
Issue to be lobbied (Desaibe in detail):
m. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/Tltle
B) Any Flnanclel, Familial or Profeaional 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
~8S 0 No: Are YOU reoresentina a not-for-Drofit corporation or entity w~out .Decial com~en$ation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions By lobbyists On Procurement Issues":
.dYes t6.0:
2)
Are you lobbvln9 on a Dresent or aendina bid for fOOds. eauiDment or services. or on a Dresent
or pendin9 award for 900d$. equioment or service?
Pursuant to Ordinance No. 2003-3395 Amendlno Miami Beach City Code Chamer 2. ArtIde VII Division 5
thereof Entitled "Camoaign Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions By lobbyists On Real Estate Develooment Issues":
Are YOU lobbvi", on a pendln, aDDlication for a DeveloDme"t Agreement with the Cltv or
BDDUcation for chanGe of zonina maD desiGnation or change to the Citv'. Future Land Use MaD?
DYes ria:
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LImNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E PENDITURES OR COMPENSAnON DURING THE
REPORnNG PERIOD.
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
reql,.lirements. ~ j _
Signal1lre of lobbyist: . ~ (. ~< ~
Signal1lre of PrincipaV ion!: (/ C!b/"- /~
VI. LOBBYIST IDENTIFICAnON: { PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced 10
Form of Identification
}(' Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
arm f Identification
~~rsonaIIY known (Principal)
I' r "~~~'~"'" GRAZlElLA L OFFEN
I E:r;&-~~ MY COMMISSION'# DO 424537
i ~"&~~! EXPIRES: July 10, 2009
: .''t..1f.j';.~ Bonded Thru Notary Public Underwriters
c _
~' . - ",;-~ GRAZJEUA L OFFEN
': . "i;;J'\;~ MYCOMMISSION#DD424537
l..l:: : We::;,.:'; EXPIRES: July 10, 2009
ll"~' '> - 'rP~'
~ I "'~' ;<~\-~." Bonded Thru NoIary Public Underwriters
~_..
FO~ A
Annual Registration fee: [ J Yes [ ] No Am. aunt Paid. . - Date palctjt ~ .~
Lobbyist Registration Form received and verified b~
I Revised 02/10/04 . \ALL\MARIA-M\LOBBYIST\LOBBYlST FORM 04