Deborah Ally/Comm AIDS
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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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Ally, Deborah M.
NAME OF LOBBYIST: (Last) (First)
Cormnunity AIDS Resource, Inc., dba Care Resource, 3510 Biscayne
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(M.I)
Blvd, Ste. 300
Miami ,
(Zip Code)
FL
(305) 576-1234
TELEPHONE NUMBER:
(305) 571-2020
FAX NUMBER:
dallv@careresource.oro
EMAIL:
33137
I. LOBBYIST RETAINED BY:
Cormnuni ty AIDS Resource, Inc., dba Care Resource
NAME OF PRINCIPAl/CUENT:
3510 Biscayne Boulevard, Suite 300, Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
(305) 576-1234
TELEPHONE NUMBER:
(305) 571-2020
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-,482 (c)l
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Richard J. Siclari, Jr. , Executive Di !rector
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
N/A
II.
SPECIFIC LOBBY ISSUE:
Miami Beach Visitor & Convention fulthorjty TOllrjsm AdvanoernPnt Program Grant
Issue to be lobbied (Describe in detail): Application
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Miami Beach Visitor & Convention
Authority Board N/A
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER): .
No cornpensatlon other than regular salary.
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), No compensation.
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
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~~No: Are vou lobbving on a Dending aDDlication for a DeveloDment Agreement with the City or
aDDlication for change of zoning maD designation or change 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 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..
Yes D No:
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 $T 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.
~~
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 all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION
PRINCIPAL IDENTIFICATION:
D Produced 10
D Produced 10
Form of Identification
Form of Identification
Ii Personally known (Lobbyist)
~ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This>><< day of -A1{J)':5f- . 20Q?
~~
Signa ure of Public Notary - State of FlOrida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This~day of !1Uf)U,r .20Q..F'
~~/l ,
Signature of Pu lic Notary - State of Florida
Notarization of Principal's signature
J FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amo& Paid MCR #
Lobbyist Registration Form received and verified by: 1,1.......' .'P~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS,doc
Date Paid
Revised 12/08/04