Glenn Pratt/Apety Group Inc.
If
MIAMI BEACH
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 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 spedfically indudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has spedfic exclusions. Please refer to Ordinance 2004-3435.
Prt{ -t-+ C- [e hI"
(Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
?- <a- s- SeV'\ LitA. A v{ '2 ~ Fl eYOV,
TELEPHONE NUMBER: '3 d ) 1 FAX NUMBER: 3 () r
1.1L-(t- I fit;. 7 L-.I 'i ~ - ) t{i'b
I. LOBBYIST RETAINED BY:
N~Rro~~JCUE~ V-u C/~, \ ~ (' 1
NAME OF LOBBYIST:
(M.!)
L'-C
(State)
Co\ret ( 6-~L It' >~ rL ,3 3iL' I
EMAIL: '3 h ~a re ~ e
tl." I, C.dwt
(Zip Code)
-11 q 0 CJ BlSC Ct -1'~Jl. ~ W S' -\. ( 6/ <i" I
BUSINESS NAME AND ADDRESS (Number and Streed . (City) I
3 a)- ~ q r- I (L I \of , II ..r - <iff \" - 1/ Lf q
TELEPHONE NUMBER: FAX NUMBER: (Optional)
M,qIA.. \ I rL 3s/~1
(State) (Zip Code)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ( " L V c- IS ti noS t!i 1 ) ~y p s .
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
ApSl S )Y\veS+MRl1 ~A~,- Od ~o
II. SPECIFIC LOBBY ISSUE:
A-n-'..+~ 6- V8-~ I kr - L\)... v L ", "" ( (;I t .., ~ 0 "J - s +-;~./ YeJl;J:+
~e lob ed (Describe in detail): Q..f h.dl/Ct ~,o"""
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
vJ
IV. DISCLOSURE OF TERM~ND AMOUNTS QF LOBBYIST. COMPENSATION (DISCLOSE WHETHEft HOURLY,
FLATRATEOROTHER): ~ \ OOt~c;) ~S ey v", c r , V\. C (v J -< &
A) LOBBYIST DISa.OSURE: (Required) .p I 6 -+ V2.. .... + R , VI C1 V.( y q II y.> V OJ (>~-\- ~
B) PRINCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): ,(Required).-F I a T f2. q. + <
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":
DYes "0: Are YOU lobbyinG on a oresent or oendinG bid for Goods. eGuioment or services. or on a
oresent or oendinG award for Goods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are you lobbyinG on a oendinG aoolication for a Develooment AGreement with the City or
aDDlication for chanGe of zoninG mao desiGnation or chanGe 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
"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..
v. SIGNATURE UNDER OATH:
ON OCTOBER 1 sr 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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
> ~ ~ y,--,,'!-
Signature of lobbyist
I do solemnly swear 'that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of lobbyist:;,x:- y ___ it . V~
Signature of Princlpal/alent:)<. ~ ""\ _.lII(j .
VI. LOBBYIST IDENTIFICATION: ----r--- JPRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
c/Personally known (Lobbyist) "11111
~\\\\\\ 11/1111.
VII. SIGNATURE AND STA~~~"~
~ Co . "~\SSJON~.. '1-- ~
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State of Florida, County of Miam~ad!t~~ . (7q"(S>,,, ~
S~orn to and sUbscrib~ before~,J,.. : ... : * E
TIlls ~ ay of fJ. Ire '" :"~~#D0300182 D: :s: ~
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Signature of Pu lic Notary - State 0 ilrauc, slt\~5S~\,~
Notarization of Lobbyist's signatur{{1II1"JlII"\\\\~
Form of Identification
Mrsonally known (Principal)
~\\\\""11""1111.
~'~~€.N WEIS ~"'~
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~ Co ..~~\SSION~.:<-11-- ~
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State of Florida, County of Miami-Da~ .:~~~ . <oo~'. OS
S~orn and subscribed before me =*: ... cP : * ~
Thls~day of ~ 2oQ.~ ~:.\#DD300182 tJ.: ~ i
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'- ~ ';"()I''''-ls\S~''.' c;s-- ~
. 'TJ ."'1111 . ~ ~
Signature of Public Not ry - State of Flo~ 'BLlc, Slt\\t. ~<( ~,~'"
Notarization of Principal's signature ~/111111IJm\\\\\\~
Annual Registration fee: ~es [ ] No Amount Pai
lobbyist Registration Form received and verified by:
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Dare Paid ,::!/-2?f4f5! 0
Revised 12/08/04