Melanie Muss/Glenn Schaffer
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 decision of any commissioner; any action, derision, 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 city 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 exclusions. Please refer
to Ordinance 2004-3435.
Muss
NAME OF LOBBYIST: (Last)
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BUSINESS NAME AND ADDRESS (Number and Street)
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(First)
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(City)
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(M.I.)
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(State) (Zip Code)
TELEPHONE NUMaER:
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIP AL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
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TELEPHONE NUMBER:
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(City)
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(State) (Zip Code)
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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORA TION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A An Financial, Familial or Professional Relationsbi
MIAMI 910058.17319011125
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE
WHETHER HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) Mwh\1 . ~,~-
.. B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ S &6fJ t &~~
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Yes com ensation or
1)
Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division
5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled
"Prohibited Campaign Contributions By Lobbvists On Procurement Issues":
ui ment or services or on a resent or
Yes
2)
Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2. Article VII Division
5 thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled
"Prohibited Campaign Contributions Bv Lobbvists On Real Estate Development Issues":
Yes
or
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK 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. ~....... /
~e 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 all reporting requirements.
Signature of Lobbyist: ~ 11
Signature OfPrinCiPal/Client:~ ~
VI. LOBBYIST IDENTIFICATION: ~RINCIPAL IDENTIFICATION:
o
Produced ID
Form ofIdentification
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Produced ID
Form ofIdentification
Personally known (Lobbyist)
Personally known (principal)
MIAMI 910058.17319011125