Barry Klein/Mark Stein
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISClOsu.e (..qu,....) fC-~ ~ AI"'-~ ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ of ~ c .f...,hJ a,1'1
D Yes ~ Are YOU reoresentinG a not-for-orofit corooration or entity without sDecial comJensation 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 "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Procurement Issues":
D Yes l'III1fo:
Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGuioment or services. or on a Dresent
or pendinG award for Goods. eGUiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbvists On Real Estate Develooment Issues":
DYes ~
Are YOU lobbyinG on a pendinG apDlication for a DeyeloDment AGreement with the City or
aoplication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
I..
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 EXPENDIT RES OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are e nd correct and that I have read or am
familiar with the provisions contained in ection 2-4 2 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced 10
D Produced 10
Form of Identification
~personally known (Lobbyist)
Form of Identification
~rsonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miam, i-oai'
Sworn and subscri re me
This ----L-day''~ ' '2U!l
~,.~ R08ema'
RJ"f. ,
. '~",.,; My ComlTlllSlOO 00198114
\: 0....' Expires March 30. 2007
State of Florida, County of Miami-Dade /
Swor SCribed before me
This -... da of 20'!.
Rosemarie Jerez
'>: .; My Commission 00198114
0. ft.' Expires March 30, 2007
FOR CLE~1tS USE ONLY
Annual Registration fee: 1?<] Yes [ ] No Amoul)t Paid I ~ MCR # 2. ~tO Date Paid
Lobbyist Registration Form received and verified by: ~~
Revised 02/10/04 F:~\AlL\MARIA-M\LOBBYISl\LOBBYIST FORM 04
'T/I/oc;;
I>l':om'Ilr.,....11
tm:d
mr
+-~
ro
,2.(103
RECEIVED
City of Mian1D$3eii_~lgf ~ City Clerk
1700 ConventionCleQ~~r l;>riv~l~ f'1iEmi Beach, FL 33139
'<,If r 'Lt:.I-';r\ ~ Ui" FICE
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 dedsion 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 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 includes the
prindpal as well as any employee engaged in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435. .
J::L6J U ~k1Z-F-tt ~..
NAME OF lOBBYISf: (Last) (First) I (M.!)
-; 00 ( Jf.~~ . . '3S(
f:
BUSINESS NAME AND ADDRESS (Number and Street) (aty) (Zip Code)
., 9C;- ~~4- vrf'f::> ~-7 ~O
TELEPHONE NUMBER: FAX NUMBER: EMAll:
I. LOBBYIST RETAINED BY:
/rI kI--/t- -::; T 61."
NAME OF PRINOPAl/CUENT:
o1~ W
BUSINESS NAME AND ADDRESS
3os- Co 1--'2- 2.. ~ ~ +
TELEPHONE NUMBER:
b ~-h
(Number and Street)'
L ~~ 140
(S e) (Zip Code)
fv\ t.V r... ~ .s. fl.l ~ <2.. t\- t 1.-. (, v............
EMAll: (Optional)
FAX NUMBER: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFACER, PARTNER, OR BENEAOARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTL V, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEaFlC LOBBY ISSUE:
~~ UP<tAJ'M.e.H ~ -S(1)6~si- r;~{L., t,ot COcJ~.s
Issue to ~ I~b~d (Describe in detail): l----r
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of IndiVidual/Title
B) Any Financial, Familial or Professional Relationship