Ryan Freedman/City Center Invst
Miami ee.xh
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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, decision, recommendation of the
City Manager or any city board or committee; or any action, dedsion or recommendation of any dty 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 dty commission, or a city board or committee. The term specifically indudes the principal as well as any employee engaged
in lobbying activities. The tenn "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last)
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BUSINESS NAME AND ADDRESS
(Number and Street) (City)
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FAX NUMBER:
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(State)
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(Zip Code)
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TELEPHONE NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCI ALjCLlENT:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
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(Number and Street) (City)
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FAX NUMBER: (Optional)
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(State) (Zip Code)
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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: ~~t=r~<E'~Qr,
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR "TRUST: \. \ I
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II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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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).
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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 /INo: :~~~ ~~~~~~n~na:,:~~ta=~:~=e~: ;o:~i:?uiDment or services. or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes f.' ::Ir::',;~~':::::'''::'':::r..:-:::::::-:~''o~::'~:::':=c'='': =~~~
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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..
o Yes (riNo: :~~:,u::=~~~n~ a not-for-Drofit corDOration or entity without SDecial comDensation
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG 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 PERIOO. ~
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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 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:
~ . lVProduced ID FL Sf/JrE .JJ~- IX) ~oduced ID ~L s/7}1'"E ~)t"_
l~;tJ Cathenne C~. Form of Identification ~ ~ Form of Identification
;. . ..; My Commission 00133628 ~ .., ~
\;.;, ~August~rsonally known (Lobbyist) g g ~.
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SIGNATURE AND STAMP OF NOTARY: U .~ g.
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VII.
[J Personally known (Principal)
".:',' ~J\ Catherine Casanova
,', ; My Commission 00133628
. . i!:..# Expires Aug t
State of Florida, County of Miami-uade us 06.2006
Sworn and subscribed before me _
This ~day of 4tlCj . 2~
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Signatu~Public Notary - tate of Florida
Notarization of Principal's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This r;:?fdayof #qtj . 20~
FOR CLER 's USE ONLY .-
Annual Registration fee: [ '~es [ ] No Amount Pa" MCR # ~ 7 q v 3 2... Date Paid 9;'" ()..!:J
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04