Adams Christopher/Goldwater Rlt
Miami ~
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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, dedsion, 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 dedslon-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specifically includes the
principal as well as any employee engaged in lobbying activities. The term "lobbyists- has specific exduslons. Please refer
to Ordinance 2004-3435.
A-bJfh1> t)/P-/STD'f/E~ b.
NAME OF LOBBYIST: (Last) (Arst) (M.I)
IV/VEL ONE, PL .' Lb77 tOLLI N5/tVE, SUITE /5t /fYJI4J111 ,gtllCH,FL,
BUSINESS NAME AND ADDRESS ' (Number and Street) (City) (State) (Zip Code) ~3 )40
y&b . fs S 3.00qq Ii/IIEL ONE &16/fr<T}I LINk ,NE r-
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I.
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/80/ Wt?5f ~e, 1It'zut,; ~/,
BUSINESS N(\ME AND ADDRESS (Number and Street) (City) (State)
50S. 5s~ ,lJ1J ?[)~. Q8. 2.q~1
TELEPHONE NUMBER: FAX NUMBER: (Optional)
g3jLII
(Zip Code)
EMAIL: (Optional)
Fill out this section If principal Is a CorponItlon, Parb1ershlp or Trust [SectIon 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIREC"n Y OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE: ~ . \
~Y/~ 1S4j1;;. t--.. 'lU~{)yr ~8
Issue to be I d (Describe in i1):
m. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ---IJ-
B) PRlNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ---CJ-
Yes ~ Are YOU reoresentina a not-for-Drofit tnrDOr'ation or entitY without soecial comnensation or
reimbursement. pursuant to Ordinance NO. 2004-3435.
1)
P~:nt ~::i~=:~. ~:~-3=~me::~tfe r:~:Ch atv Code Chaoter 2. Article VII. Division 5
T _. f E'" . F" e "Vi . . n Of Code Section 2-488 Entitled "Prohibited
Cam~ian Contributions Bv lobbvists On Procurement Issues";
Are ~ IobbYina on a oresent or nendin~serv~~' eauioment or services. or on a oresent
or _I;;-~ard for aoods. eauioment or serv~?
~=t"~~~i~~.:. .2:0~:=5 ~~dina ~~ eeag Citv Code. Chanter 2. ~Ie VII D.iv!sion 5
h- " m l....nFIO_n__ _rm"_ V _ The __on_ Code Section 2-490 Entitled "Prohibited
a;m;;~n Cbntnbtrtions BY lobbYists On Real Estate Develooment Issues":
Yes ~
2)
YesB
::=:,bb~~n~~e~~~":~=~:=:a::=r:~~~~=::a~ ~ Mao?
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SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE arv CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
REaIVED, IN THE arv OF MIAMI BEACH FOR THE PREaDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATI~~7RING THE
REPORnNG~ ~
Signature of La byi
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.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTlFlCAnON: PRINOPAL IDENTlFlCAnON:
~uced 1D1I3J~" /e?Y""? -1':27-0 0 Produced ID
7-/-. P,l.- Form of Identification ~ Form of Identification
o Personally known (Lobbyist) ~~known (Pri~
YD. SIGNATURE AND STAMP OF NOTARY:
----." -
. . .~. E. WEINSTEIN
:~ MY COMMISSJON # DO 158393
EXPIRES: February 15, 2007
8ondod Thtu Nolary Public Undo<wril8rs
FORCL.E 'SU~LY. .- ~.
Annual Registration fee:tt<l Yes [ ] No Amount Paid . , MCR # .z:r:+3=\~ Date Paid I ~OS
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER LL\MARlA-M\LOBBYISf\LOBBYIST FORM 04