Sean Ellsworth/No. Beach Ctzns
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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 "Lobbyists" 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
?oS- 535" 2.'-1.. ;
S eO(. n.
(First) (M.!)
full\. ~ -#,S'"O ~.Q.-d ~ 1 fJ~
umber and Street) (City) (State) (Zip Code)
~(\!l53f;~~~S'\ S~~el\sl~uJ.c.()~
FAX NUMBER: EMAIL:
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
to 0 ,,~ Re..ct. c I-t C, 1-\" <..t!., k S
NAME OF PRINCIPAl/CLIENT:
st. 1a.5-et lis -.Sc.kClC) \
BUSINESS NAME AND ADDRESS (Number and Street)
ik Clt ~OI-f.e. N'e.lG\.b\V"koO J.
K~' "L~~ ~~c..k -FL
(City) (State)
3 f}Lf: I
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
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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, A5% OR M,ORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: . "
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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 RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) cp ~ 0 BO)J V
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).--.2R 0 ~ 0 N 0
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":
~ Q HlI: Are you lobbyina lIn a present Qr oenclina bid for 9*S. ~Uiament or servi~, or on a
Dresent or Dendina award for Goods. eGUiDment or servic_?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~Are ~Oll ~obbYina on a .ocndin~ i!oolicatio~ fllr ~ DeYeio:me:~ ~~~:'J~~h .~hl! Cicr ~r
". aDDhcatlon for chanGe of zOninG maD deSIGnation or ch_na_ 0 _he CI_'_F __or _ Lan_ I:Le
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, 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 ,wjthout special compensati~n Or reimbursement for the ~ppe9raf1Ce;. ~"'ether 'dire.ct, or
'\' incnrect,"to express support of or opposition to any itE!m, shall register with'the clerk as required by this
sectio but, shall not be required to pay any registration fees..
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SIGNATURE UNDER OATH:
'.
ON OCTOBER 1ST OF EACH YEAR,. EACH LOBBYIST SHALL SUISMIT TO THE CITY CLERK A SIGNED
· STATEMENT UNDERQATH,j, LIStING 'LOBBYING' EXPENDITURES, ,AS )\tELL-' 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
REPORnNG PERIOD.
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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:
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Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC~TION:
''', 6\.' "y:J ,
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t:- Form 2f Identification D.
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IJ Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
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[~l Producecf 10'
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Form of Identification
[] Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn and ~l:Ibscribed before r)'le
is~day'of ' ".,'~ 20_
nature of PubHc Notary - State of Florida
tarization of Principal's signature
FORCLE~EONLY ~ .~1""
Annual Registration fee: [ ] Yes [ ] No AmoU~id ~ MCR W=11U\ I Date Paid 9/?l-/~
Lobbyist Registration Form received and verified by: '-- ~
F:\CLER\$ALl\MARIA-M\Lobbyi5t\LOBBYIST fORM OS.doc Revised 12/0A/04
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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 lobbymg activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
EIISlJ./ortit
NAME OF LOBBYIST: (Last)
o lJ A..,<) h ,t -I\.
BUSINESS NAME AND ADDRESS
?O~ 53S- 2.'- ~ ;
S' <ect V1
(First) (M.I)
full\.. ~ -#,5"""0 ~.Q.-..l ~ 1/3 (
umber and Street) (City) (State) (Zip Code)
20.5"' 53f;~ ~~S? \ S~~ells'~uJ .c.c tv1
FAX NUMBER: EMAIL:
f/l
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
t0ov~ Re-Ci.clt C', t," <..~k S
NAME OF PRINCIPAL/CLIENT:
<:;t. Ja.5~f kg ...sc.k~o \
BUSINESS NAME AND ADDRESS (Number and Street)
1lH- C< S~ N'e.lc;\.b\V"kOO J.
M.~''t\\.\~ .&e~c-k f?L
(City) (State)
3 f}4: I
(Zip Code)
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, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
<65"1 fk rd ~ I.:, ~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ f( 0 130!J"D
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReQUired).-2R. 0 b 0 >>0
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":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
l
. 3) Pursuant to Miami Beach Cify 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 appe~rance,'_ whether 'dire.ct, or
indirect,' to express support of Of' opposition to 'any item, shall register with' the clerk as required by this
sectio but, shall not be required to pay any registration fees..
V. SIGNATURE UNDER OATH:
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.
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Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true
familiar with the provisions contained in Section 2-482 of
requirements.
Signature of Lobbyist:
~
nd correct and that I have read or am
Miami Beach City Code and all reporting
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
,{~ pr~uced ID'.M~c~ ;:?::1.[!R-).~_L{>
Form 2! Identification)
t.-- If,Jl- 'If 3-6fJ ~ I sv-- L
II Personally known (Lobbyist)
I") Produced ID'
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Form of Identification
U Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed efor: me Sworn and subscribed before me _
Thisr?7"h day of ':"-"'?:'~"'~~is~daY'of , ,20_ .
, I/" ,'~'6,::"v.!'.~iJ::.~ KERRY HERNANDEZ I
"k*~" ,;t;, ";,: r"lY (;OMMISC:101I J! C[II-'c4Q< I~
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Sign ture of ublic '.__ _ - 'florm: P:1l! NlJt2rY I\,~"': l)nJdV.',!dS nature of Public Notary _ State of Florida
Notarization of Lobbyist'$"~~""-;O;;-~9<.~-;'~~__~~ tarization of Principal's signature
FOR CLER~E ONLY, :b', :ki.-r
Annual Registration fee: [ ] Yes [ ] No Amount Paid _ ~ MCR W T r C Date Paid 9 Pl-/~
Lobbyist Registration Form received and verified by: '- J....--.; ~~
F:\CLER\$ALL\MARIA-M\Lobhvic;t\1 ORRYTC::T mOM nc .-4M