Elaine Roden/Watersports
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ECEIVED
City of I:1JPMJ(J34!ij):t-PefflhEfi<n the City Clerk
1700 Conventi~.n cenf~L,R[iV~r-!1~i Beach, FL 33139
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LOBBYIST REGISTRA nON FORM
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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, recommenaation 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
r&f.EN ~LA/,jE tYl.
NAME OF LOBBYIST: (Last) (First) (M.!)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
JOr ~61 8~7h 30) :J?6/ lm/f/ ~/aW @/~ih{!Jld. Co~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS
30) d1;1 lJ?7{,
TELEPHONE NUMBER:
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(State)
(Zip Code)
CII
(Numb and Street) (City)
(~ar ~61 ~lff
FAX NUMBER: (Optional)
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:
l!olJlIt./J J..]. Sl(I1N~
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
NONE'
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes rio: Are yOU lobbvina on a present or oendina bid for aoods. eauioment or services. or on a
present or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are you lobbvina on a oendinaaoolication for a Develooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
MaD?
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 o~ritity 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..
~s D No: Are you reoresentina a not-for-orofit corooration or entity without soecial comoensation
or reimbursement.
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.
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Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and, correct and that I have r.ead or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
reQuirements.//7 . .",y
Signature of Lobbyist: ~~. t$dv.. -;/'lddfA-P.. ;fJ:J4;.I-L ""-
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
D Personally known (Principal)
State of Florida, County ~~i.mtleacau
Sworn to and sUbscribed~JrMY Commission 00086681
This 10 d of ~~......'" E;x~sJanuary27,2006
AV~V~t ;)005
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
a~"', FOR CLERK'S ~EONLY
Annual Registration fee: [ ] Yes [ ..;(NO. Amoun~ 'f.-Y MeR #
Lobbyist Registration Form received afld -verified by ~ e:<..
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 . oc
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Date Paid 23 "laDS
Revised 12/08/04