William Eager/Related Group 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 pdndpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of t~e
City Manager or any dty board or committee; or any action, decision or recommendation of any city personnel dudng the time
period of the entire decision-making process on such action, derision or recornmendation that foreseeably will be heard or reviewed
by the dry commission, or a dty board or committee, The term specifically includes the prindpal as well as any employee engaged
/o lobbying activities. The term "Lobbyists" has spedflc exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) - (Fi~l:)
BUSINESS NAME AND ADDRESS ' - - (~u-mber and Street) (Qb/)
TELEPHONE NUMBI~R: FAX NUMBER:
BUSINESS NAME AND ADDRESS (Number and Street) ' (C~y)
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(State) 'iZip Code)
""
'(State) ~ (7~p Code)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFF[CEE. PARTNER. OR BENEHC~ARY:
- IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORAllON, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY ISSUE:
I.e ~ be iobb.~~ in de'il): ; / - / /
~Z. ~ AGEN~ES/~D~A~ ~ BE LOBBED:
Full Name of Individual/Title
Any Financial, Familial or Professional Relationship
L16'
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ZV. DZSCLOSURE 'OF TERMS AND AMOUNTS OF LOBBYIST COMPENSA'r~oN (DZSCLOSE WHETHER
A'~ 7'RARE OR OrHffR):
A) LOBBYIST DISCLOSURE: (Required) .~'b~/rI.L,~_
13) PRINCTPAL'$ DLSCLOSURF (OF LOBBYTST COMPENSA'i'[ON): (Required) [~)~
The following information must be answered:
1) Pursuant to Miami Beach Ob/Code Section 2-488 EnUtled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes ~o; Are you lobbvina on a DreMnt or ~endina bid for Ooods, eouiDment or services, oron a
preaent or pendina award for goods, eouiDment or service?
2) Pursuant to Miami Beach City Code 2-490 EnVied "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
t;~¥es ~o: AJ~e you Iobb¥1nq on a oendine aDolication for a Development Aoreement with the Cit~ or
aoolication for chanqe of zonine mae desienation or chance to the City's Future Land Use
MaD?
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 representaUve 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
sect~,O but, shall not be required to pay any registration fees..
Yes LT,~o: Are you reDresenUna a not-formroflt corooraUon or entity without soecial comoensaUon
or reimbursement. .
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEARv EACH LOBBY[ST SHALL SUBMIT TO THE cTrY CLERK A S~GNED
STATEMENT UNDER OATH, I~SlING LOBBYLNG EXI~ENDZTURES, AS WELL AS COMPENSATION
REC:EZVED, IN THE C[I'Y OF MLa~I! BEACH FOR THE JP~ING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN :IF THERE HAVE BEEN NO ~I~pTrURES OR COM~TION DURING THE
I do solemnt¥ swear that a~ll~ the forgoing facts are true and correct and that I have read or am
familiar with the provisions ~t~ained in Section :>-482 of the Miami I~c_.h Oht Code and ali reporting
Signature of Lobbyist: I ~
Signature of Princlpal/Olent:
LOBBYL~T IDENT~F/CA1TON:
!".? Produced ID
Form of Zdentificafion
,.~.~Personelly known (LobbyLet)
_sVZtal:e of FioSZ:a,NA=: o::iam,STA. DM~P2,~~+~'.:,a,'~'
5worn t~.i~nd subscribed before rhea?
This (~ day of~
Si§natUre of Public t~:~ry - St~t~ of Flodda
Notation of ~~t"~
PR~NC2PAL ZDENT~F~CA1/ON:
I':, Produced
Form of Identification
~.~ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of ,20_
Signature of Public Notary - State of Flodda
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR #
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARTA-M\Lobbyist\LOBBY~ST fORM 05.doc
Date Paid
Revised 12/08/04