Alexander Tachmes/A. HerranMIAMIBEACH
City ot: Miami Beach ~ of tl~ City aerk
1700 Conv~n Center Drive, Miami Beach,, FL 331.3~
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1V. D/SCLOSURE OF TERMS AND AHOUNTS OF LOBBY[ST COMPENSAT][ON (DZSCLOSE WHETHER HOLIR£ ~
FAA T RA rE OR 0 THER,):
A) LOBBYISTD]SCLOSURE:(Required)~S~'00 ~ ~~
B) PR]:NCIPAL~ DLSC~OSURE (OF LOBBY[ST CO,PEN:SAT[O,)= {,,.ire,).C~~~ 0(.~ ~J:2~ ~
The following information must be answere~l:
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
3 YeseS.No: _ Are,y.o,.u Iobbvin= on a _D _ ~resent or ~endinqb_id for_._Cto.ads, eauiDment er services, or ona
m~sent or _aen___dina award for ;oods.._.eauioment or service?
__
2)
Pursuant to Miami Beach City Code 2-490 Entitled ~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues#:
DY~ ~l[ NO:__. .Are you Iobbyin~ on_a_~endin= aDplicaU_o.,n for a Develomnent. Aareement with_the City or
apuli_mation for chanQe of zonin; mar~desi._enation or chanae t~, .the City's Future. Land Use
Ma~? *
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 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 derk as required by this
section but, shall not be required to pay any regist~tion fees..
_D Y,~ 1~, ~No: Ar~ you ~_nr,~entirm a not-for-orofit_ coroorati0n o._r entity without_special eompensation
er reimbursement..
V. S:[GNATURE UNDER OATH:
ON OCTOBER Is~ OF EACH YEAR~ EACH LOBBYZST SHALL SUBMIT TO THE CITY CLERK A SZGNED
STATEMENT UNDER OATH~ I.ZST]:NG LOBBY]lNG EXPENDITURES, AS WELL AS COMPENSATZON
RECEZVED, IN THE CZTY OF MLRM][ BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEMENT
SHALL BE I~LED EVEN ZF THERE HAVE BEEN N URZNG THE
REPORI'~NG PER/OD.
.
Signature of Lob[hist
I do sotemnly swear that all of the foregoing facts are true and correct and that [ have read or am
familiar with the provisions Hiami Beach City Code and all reporting
SignaturerequirementS'of LobbyiSt:no. al . . .~.~~~~~ /.~_.
Signature of Pti p / :lient:~.,~._'
VII. LOBBYIST I'DEN'T~FZ~~I/ -c---..---------'~ *~P~NC11~AL ZDENTIFZCATZON:
-' Produced ID ~ I' Produced ID
Feqn of Identification Form of Identification
Ij~;,/Pe/rsona[ly known (Lobbyist wn CPrincipai)
V~. S/GNATURE AND STAMP
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade~,'~f~ MY COMMISSION # DD 126401
Sworn to and subscribed before me Sworn and subscribed before me * t,~~ *
This ~i~_.~_~Y Pf~ ]~¢..~t~ , :20~__~ This~r~a¥ of _-Z-~..~L.~qt\_~, 2.~~~<~. EXPI~S: June16, 2006
'~ ' Signature of Public Notary - State of Florida
~gna~ure ofgub~i¢'~a~r--s~ o~ F~orida
Notarization of Lobbyist's signature Notarization of Principal's signature
..
~ Fo~ CLEaX'S USE ONLY -----
Lol~yist Registration Form reoeived and verified by:
F:\CLER\$ALL\NARIA-M~Lobbyist\LOBBY[ST fORM 05.doc Revised 127'08/04
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