Roney Place Condo Assoc.
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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 dty board or committee; or any action, decision or recommendation of any dty personnel defined in any
manner in this section, during the time period of the entire dedsion-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specifically includes the
principal as well as any employee engaged in lobbying activities, The tenn -Lobbyists'" has specific exdusions. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First)
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~SINESS NAME AND ADDRESS (Number a Street) (aty) , (State) (Zip Code)
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TELEPHONE NUMBER: ' FAX NUMBER: EMAIL:
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I. ()_ LOBBYISTRETJfNED BY:
KDNei PfJlrl-CE G/'IDlJ.r11t IVltJ(I1 aSSOC, .:cNc~
NAME OF PRIN PAL/CUENT:
Oi3o I C I lor S Ii (/ f.. fJ1 (/4111/ t3 [flcf! , FI- ::3 a / B 9
BUSINESS NAf"'iE AND ADDRESS (Number ana Street) (at;) . (State) (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)]
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. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICARY: CJl
WAYN2 BAil/IN I paeslDENT .:-.,. ~
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST fil SUet;:b
CORPORATION, PARTNERSHIP OR TRUST: .s:.~ I'\)
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II. SPECFIC LOBBY ISSUE: I ? " 0
~~~\ ~Et>~~.tTA\(ON CotJCE:.etJlN3 t\l\ NOt$: +EN\E.2.Thn~Jm(M- &u~s IN (\\\At\\\
Issue to be lobbied (Describe in detail): ~\\
III. CITY AGENOES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title
B) Any Flnandal, Familial or Professional Relationship
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IV. · DISC.'l.OSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE jHETHER HOUR! ~
FLA T RA TE OR OTHER): OC;) ~ 00
A) LOBBYIST DISCLOSURE: (R_lred) ~S.OO(:). ~INi:.~1 8'15. I-\o~ .II. o~
. 00 li .. 375.
B) PRINCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): (Required). 5.J CX)O. n~l NE:R... J
D Yes l~ Are YOU reDresentina a not-for-Drofit corooration or entity without soecial comoensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
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D Yes ~~ ~_ 10 ~ 1__ __ a _____ _ ______ __ __r __so eauIDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbyists On Real Estate Develooment Issues":
DYes ~ Are YOU lobbyinG on a DendinG aDDlication for a DeveloDment AGreement with the City or
aDDlication for chanGe of zonina maD desiGnation or chanGe to the City's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO PE DITURE OR C E SATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of t foregoing facts are true and correct and that I have read or am
familiar with the provisions contai ed in
requirements.
PRINCPAL IDENnFICATlON:
Signature of Lobbyist:
Signature of Principal/Client:
VI.
o Produced 10
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o Produced ID, -:?
Form of Identiticati~
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.xPerSOnallY known (Principal)~~:. N
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Form of Identification
~erSOnallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, C~~tfjnmi-Dade l-D~al/ IS"" State of Florida, County of Miami=!)ad~ 0
Sworn to and ~~~.~e . d' M _Sworn and subscripe9 before mete') .;::
This ~~at~{;>>\SSID~~..~ ~o_ /1 Iv' Ztlb5This ~day of ~{J (/ , 2lrtl ,)
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Signature WIC Nom'9"- S~ ~Io'" 0 ...~~~~11'./ ~ Signature of Public Notary - State of Rorida
Notarizati I.GlGifjt3i si'~nF ..o~y.\SS/ON ~~.. ~otarization of Principal's signature
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Annual Registration fee: [j] Yes [ ] No Amount . . .MCR #;J f /) Y3 Date Paid /1/ el tP-/~...
Lobbyist Registration Form received and verified by: _ I /
Revised 02/10/04 F: d E \AlL~l\rlA;';M M'{toBBYIST\LOBBYIST FORM 04