Lori-Ann Cox/FIU
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am
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Oty of Miami Beach Office d the Oty Clerk
1700 COnvention Center Drive, Miami Beach, FL 33139
LOBBYIST UGISTRATION FORM
Lobbyilt means all peqons employed or retained, whetMr peJd or nell, by . prtndPl' who seeIcJ to encoul'ilge the paAQe, defeat
or mocIlfIQtion of any ordll'llnCe, relOlution, .ttion or d~ of any comml&siGncri IIny eetIOn, dee!lion, reCOlm'lCllMfBtion of the
cay MInIger or en)' dIV boird or camnittn; or InV ICIIon, dedtion or ..ommendlldon 01.", c;ty personnel during the time
period t# the entire dedsion-nkint proc.u on such ICIian, *dIIon 01 reconvMndltloft th;tt forM....v.,.1I be "'.rd or reviewed
by the city commission, or. cit.y btJard or eon",.t*. lhe tIItm specll~1ly Indudel the princIpM IS weU. any emplayw engtl(1<<l
in Iobbyine ecIIwitia. ........ ......,...... .....,.anc ac....... ..... '.r t6 OrtllaMc. 2004-JoUS.
COx LOfJ-/id'JN '1::1
NAM! OF l088YJST: (1.Ht) (First) (M.1)
FLOe-lDA 11\JT~~~T,lNAd- U~ Vl~e6ITL Ml A:M I J E.L- 331g.9
BUSNSS HAM! /H) ADDRESS (Number .nd 5tnIet) (CIly) (Stile) (Zip Cod.)
3/")6ct12-=f. -tf34 ~~2-+- \402~e...a-~N .C..i)X@ ':='U.ED.i
TELEPHONE NUMBER: PAX NUMBER: EMAlL:
L I.OI8YIST RETAbIED .Vt
FtaJ DA IrSfet-tV.6cf1 OI\Jf><L, UI\Jl1ft:i417'-r
HAM! OF PRN:IPAl..JQJENT:
~ '12,00 , btt0 87~1 ~T J\..A l f\M
BlJ5JNESS NAME AND AODRe5S (Number and Street) (CIty)
~S ~4B- 2COO
NUM8ER: FAX MJ"'A~ (~al)
~
(Statle)
33 \,:j C,
(Zip Cod.V
EMAIl: (Option at)
.. .uttMaMCtllNt If
... c.po....~ ,....,...., or TMII [SedleB 2-482 (c))
· NAME Of CHU!F 0ffJC!R, PARTNER, OR IENEFJCARY:
M Itc.g cO 5 ^'. ~e2-
· IDENTIfIY ALL PERSONS HOlDING, DJREmy OR tHOIA!C1\.Y, A Sew. OR MORE OWNERSHIP INTEREST IN SUOf
CORJtORAllON, PARlNIA$HlP OR 'TRUST:
Nl.J~l-'--
II. SPeCIFIC lO8aV ISSUE:
5 b~ ~IN"BA.'1:>lb Ft;6TIV AL.. \fr-A. 6 ~
tuuc to be Iabbled (DesCflbe In detaII)~ 9
lB. CITY AGENCI!5/JNDMOUALS TO IE LOBBIED:
A) F.. fUIM of """"'''/11tIe
.) An, FIn.,.;18', ......... Of ,,.,........ .........,
rJ,A.
3056241402 P.04/08
SEP-28-2005 14: 47
IV. D1SCLOSUIU: OF TERMS AND AMOUNl'S OF L088YIST COMPENSAnON~(DWH::t:jntlY,
FI.A r RA~ 011 tJ71tDI):
A) LOB8VIST D1SQ.OSURE: (.......,...) -1iQJ COMf~ 1BO .
-'l 8) PAINCIM. 'S DISCl.OSURE (OF I.OIIMSI" ClaMPI!N5A'IIDN): ~.
Tlte foIIowi... infor_8tion ftIUSt be ..........:
1) ~ to Miami Belch City Code SectIon 2..488 Entitled .p~ted Campaign ContribuUonl By LobbyiSts
On Procurement Issues":
~ :!!::::== =::~=:::!i:.,u18.._........4lMt -ao.
2) Pursuant to Mlamt Beach Oty COde 2-490 Entitled "Prohibited Campa4gn Contributions By Lobbyists On Real
!state Development Issues.:
cr.€)=,==~.:=.:...~:..~~~~
IIIaZ
3) PursUlnt to Miami Beach OtV Code 2-'484 (h) Arft person (except those exempt from the definition of
"lobbyist" as set forth in Section ~-41 above) who cnv appears as i representative of a not-for-proftt
corporation or entily wiU10ut spedal compensation or reimbwsement for the ilppearance, whether direct, or
Indirect, to express SUppOrt d IX' opposition 10 any fteln, shalf reglsta- with the clerk as requred by this
section but, shaN not be required to pay any regiStration fees..
<9 g.... :-..,":...-=~ .~- ......---.-daI-.._1is!II
v. SlGNA1'URr UNDER OAtH:
ON OCTOBER 1ST OF EACH YEA' EACH L081YIST SHALL SUBMIT TO THE CITY CLEftK A SIGNED
STATEMDIT UNDER OATH, umNCI L088Y111G EXPINDlTUUS, AS WILL AS COMPINSAnOH
RECEIVED, IN THI CITY Of MIAMI IIAeH FOIl THE PRECEDING LENDAR YEAR. A STATEMENT
SHALL IE PILED EVEN IF THERE HAVE "EN fIO EXPEND PI:n: NO THE
REPORnNG PERIOD.
VI. LOUYIST IDENTlFlCAnON:
o Produced 10
Form of Identification
/' Personally known (LobbyWi)
o PersonaUy known (Principal)
@
NoIafy Public State of FIorlda
Dawn M Schwagel
My CornmiIIion 00397164
Expires 0410212009
-7
VII. SlGNATURI AND STAMP Of N01'ARY:
State r:J Florida, County of MIami-Dade
Sworn In and subsct1be<I tNlI'ore me :---
This 2~ div of ~ zo.fi5
~
Stall! of Florida, COUltV of Miaml-Dade
Sworn a d me
Ttu
~
FOR CLEaK'S USE ONLY
AnnutII Reglatration fee: [ ) Yes { ] No AmDunt PIIId MCA it
Lobbyist "'Qi5tnItton Farm received artd verlft*<t by:
F:\ClER\$ALL\MARtA+1~YJST fORM os..
Dare Paid
R4IYiHd 1~/08/04
- - - - - -
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· eE Nile. _oIfIIlIIda
I . _~.m
, · ~#llDIG9'O l
. I .......,NallardNalllY'-"
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