John Herin, Jr./Solomon ZalmanMI, MIBEACH
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.
NAME OF LOBBYIST: (Last) (First) (M.I)
15o
BUSINESS NAME AND ADDRESS '(Number and Street)"- (City) ! ~ (State) (Zip Code)
TELEPHONE NUMBER:
FAX NUMBER:
EMAIL:
I. LOBBYIST RETATnED BY:
NAME OF PRINCIPALTCLI~-N I:
BUSINESS NAME AND ADDRESS (Number and Street) (City) ' (State) (7ip 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:
II. SPECIFIC LOBBY ISSUE:
I~sue to be lobbied (Describe in detail):
Cl'rY AGENCIES/INDl%/IDUALS TO BE LOBBIED:
A) Full Name of Individual/TiUe
B) Any Financial, Familial or Professional RelaUonship
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ( . ~ ~ ~
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":
[] Yes E]~lo: Are you Iobb¥in.q on a present or pendin,q bid for floods, equipment or services, or on a
/,
oresent or oendino award for ooods, eouiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
E]Yes~ No: Are you Iobb¥in.q on a pendin.q application for a Development A,qreement with the City or
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application for chanqe of zonin,q map desi,qnation or chanqe 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 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..
[] Yes ~/No: Are you reDresentinq a not-for-profit corporation or entity without special comp~n~pt;ign
/ ~ or reimbursement..
v. SIGNATURE UNDER OATH:
ON OCTOBER Is~ OF EACH YEAR~ EACH LOBBYIST SHALL SUBMZT TO THE CITY CLERK A STGNED
STATEMENT UNDER OATH, LTSTZNG LOBBYTNG EXPEND~TURES~ AS WELL AS COMPENSATION
RECE~ED~ [N THE C[~ OF MZAM[ BEACH FOR THE PRECEDING CALENDAR YEAR. A ~ATEMENT
SHALL BE F~LED ~EN ~F THERE HAVE BEEN NO EXPENDT UR~ OR COMPE~AT~ON DURZNG THE
REPORTING PERIOD. ~
~ ~i0na~re of Lobbyi~
I do solemnly swear that all of the foregoing fa~ are~ue a~d corre~ and that I have read or am
familiar with the provisions contained in ~e~n 2-482 of ~ ~iami 8each Ci~ Code and all reposing
requirement. I ~ _ ,
Signature of Lobbyist: ~~ /~?/
Signature of Principal/Client: ~~ ~' ~~~
VI. LOBB~ IDENTIFI~ON: PRINCIPAL IDEN~F~ON:
~ Produced ID ~ ~F~f~d~t;;~iT/~ ~ Produced ID ~ ~dle~o~-~
[] Personally known (Lobbyist)
[] Personally known (Principal)
VZT. STGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ! '~/'~ day of ~-~-~*~,~,~ 20~~¥'
- ~ ~ '~'~--~ DD124~
S gna ure ....
Notarization of Lobbyist s ~u~n '-
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This /? ~L day of.~,¢~'~ ~', 20~'
.... ~ ~ ~'M J'~ Ki~.~ Jr
Signature of Public Nota~tate ~i~ '
No~rization of Principal'~ ~igna~ ~im
/~"" ' FOR CLERK'S USE~ONLY ~ / ~1~
Annual Registration fee: [ ~' Yes [ ] No Amount P~J~/' ~'~-~/ MCR # Z
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MAR~A-M\Lobbyist\LOBBYIST fORH 05~oc
Date Paid ~-~~(..
Revised 12/08/04