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City of Miar65~m:~ @ffm ~~ ~ City Clerk
1700 ConventionC~nter Drive, Miami'Beach, FL 33139
LOBB~IST Ri&fs~~ ~IJ~~bRM
m
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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, decision 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 specifically includes the principal as well as any employee engaged
in lobbying activities. The tenn ftLobbyists" has specific exclusions. Please refer to Ordinance 2004-3435:
!J(}",')&I1fJ{1// Y4
NAME OF LOBBYIST: (Last) (First) (M.I)
JY')/IlIYl/lh:KfltJ~sIoelS {jjJr;ee, ~OOIIJN;1N ('JtHK.j/V If1.I5.sJ/tt-1
BUSINESS NAME AND ADDRESS (Number and Street)' (City) (State) (Zip Code)
1.50)' ;jlal j(l?7~ 3a> d'6/ (fl( lfl
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
/YJIJ4/J11 ~~l1CfI ItJA1"B?,,--"SP0Je!\5
NAME OF PRINCIPAljCUENT:
C&vTif: ) I Ale~
,
~s-oo I~II/J (~;:,6t;~(. ,rllllffll e6J1el-f
BUSINESS NAME AND ADDRESS (Number and Street) (City)
30,-- ~/ ~7h 30J 8bl <!XII-I
TELEPHONE NUMBER: FAX NUMBER: (Optional)
.
fL
(State)
33/'1/
(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:
(OAlIli..tJ tJ, SH/I/./k.
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
. .
II. SPECIFIC LOBBY ISSUE:
MIAMI 8~u V cA uLAN! ltfJ/JurAlIOA.!
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
vcA
./
NON~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOtJRL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
NON~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
N()I(j.c
The following information must be answered:
I} Pursui'!nt to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes
2)
, \~'\
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..
ltYes D No:
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TOTI'tE 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.
~
Signature of Lobbyist
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 ali. reporting
requirements. ,/'
Signature of Lobbyist: ~~ ~
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
o Produced ID
Form of Identification Form of Identification
" Personally known (Lobbyist) vS1h'ff. Of llrir~allY known (Principal)
f\. :l'~'l \lUV>U 'ne \\011 78
VII. SIGNATURE AND STAMP ~O Ry:t\~\ ion 4H)\)'37~08
COn1:rnlS~ \)tC. 09, nC.
State of Florida, County of Miami-Dade ty.\l\r~'. c ionQiU~OCl( Florida, County of Miami-Dade
Swom to aod 'Ubsai'if'{J"':',O~~ ~e . . ""'" ."",u Sworn aod ,ubsaibed befo", me
This lfY\. d of 20~n e This _day of ,20_
fl
Signature of Pub IC Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
FOR CLERK'~.lJSE ONLY
Annual Registration fee: [ ] Yes [ -1-No Amoom Paid N / A MCR # ~} /A:-
Lobbyist Registration Form received and verified bY~\~ ' ,
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM O. c
Date Paid 810-cG"
Revised 12/08/04