Michael Kaul/United Box Inc.
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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 ordiqa,r;u:e! resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any tity boarClor 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.
~~~IST: J' M ~~6l- (First) (M.I)
JMJt<AtL tAVl..-APa1 ~ I~ I~WUJUJNS^Vr:ltllO M.~ ~313~
BUSINESS NAME AND ADDRESS (N1Jmber and Street) (City), . (State) (Zip Code)
~O~.~J5' ~~; j(j5'B05 eJb?>!J ~~ ~ ~,'IMft.CtJ11IV
TELEPHONE NUMBER: FAX NUMBER: . EMAIL:
I. LOBBYIST RETAINED BY:
UNlft5D ~X INC
NAME OF PRINCIPAl/CUENT:
C/O f;()O MADr~btJ /We ~1l2- N~\\J'(Of<K
BUSINESS NAME AND ADDRESS (Number and Street) (City)
tl~. ~e>o ;'300
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(State)
(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:
Kml,.O blANCA~1>1
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR.. INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
f1elf<~ of .~~ CLAUDLO 5UC,/OL.
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS 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)j
FLAT RA TE OR OTHER). NONe
A) L.OBBYISTDISCLOSURE:(Required) ~ r^~T of ~Cf-t(1"EL!VRAt.- ~VvS
~ /N(/l,.. \N FeG af A'edVC:
l'JoNe
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
D Yes ~o: Are YOU lobbyina on a oresent or oendina bid for aoods, eauioment or selVices. or on a
oresent or oendina award for aoods, eauioment or selVice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are YOU lobbyina on a oendina aoolication for a Deyelooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"Iobbyisf' 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 ~, Are YOU reDresentino a not-for-Drof"rt corDOration or entitY without SJ!ecial comoensation
or reimbursement. .
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 URING THE
REPORTING PERIOD. C
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
~"::\i::m~:.the provisi h City Code and all reporting
Signature of Lobbyist:
Signature of PrincipalfCIi -. - .'. .
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced 10
Form of Identification
~rsonallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
;(personally known (Principal)
State of Florida, County of Miami-Dade
Sworn ~nd~subscri~ before me
This / t<..-day of . ~h:r-. 200.5
~ ~UbIiC Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary ~t~te sf r;IQrid.
Notarization of Principal's signature
FOR CLER '5 USE ONLY ~ a:
Annual Registration fee: [~[ ] No Amount Pa' MCR # I -/(5 3 J
Lobbyist Registration Form received and verified by:
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