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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, 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 term "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
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(Last) (First)
1. S is
(Number and Street) (City)
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NAME OF LOBBYIST:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
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(Number and Street)
4l/jJ..
331
(Zip Code)
BUS ESS NAME AND ADDRESS
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TELEPHONE NUMBER:
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, DIRECfL Y 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 lobbi (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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ISE ON;~R # 1 77 9~O '">ate Paid
FOR CLE
Annual Registration fee: [ "'1'Yes [ ] No Amount Par
Lobbyist Registration Form received and verified by:
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM OS.doc
Revised 12/08/04
of Pul}f'ic Notary - State of Florida
Notarization of Principal's signature
SiJhature of Public Notary - Statl
Notarization of Lobbyist's signature
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State of Florida, County of Miami ft_:Jl1f..f:\'
d subscribed before me
day of 5.P~Wlh.t (. 20
PAULA MAJOROsn-:.
MY COMMISSION # DO ~1~~
EXPIRES: November 8, 2008
nded Thru Notary Public UndelWrRers
State of Florida, County of Miami-Dade
Sworn to and subscribeq before,
This A-I ~ day of ~eokM
PAULA MAJOROS
MY COMMISSION # DD 310341
EXPIRES: November 8, 2008
BoIlded Thru Notary Public Underwriters
SIGNATURE AND STAMP OF NOTARY:
VII.
o Personally known (Principal)
, Personally known (Lobbyist)
I(Produced ID fL vI"..i.fLO-/'75 ,"'-1 R - W/-O
Form of Identification
Form of Identification
o Produced ID
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.
v. SIGNATURE UNDER OATH:
3) Pursuant to Miami Beach Oty 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..
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2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
The following infonpation must be answered:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYI~ COMPENSATION (DISCLOSE WHETHER HOlJRLY,
FLA TRA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (
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