Steve Marin/Fla Graffiti Control
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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 city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, 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.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
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UMBER: FAX UMBER:
A..
(State)
(M .I)
33/1'
(Zip Code)
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CUENT:
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(City)
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(State)
-730JY
(Zip Code)
,..-112l?
FAX NUMBER: (Optional)
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: ~6 ~ :t> '^~~
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDI~Y, A 5% OR M RE OW ERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: <eJ::J :ctD (
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II.
SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). .j- S:O~
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A) LOBBYIST DISCLOSURE: (Required)
1)
.vices or on
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Artide VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaign Contributions By Lobbvists On Real Estate Develooment Issues":
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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORIlNG PERIOD. .g:;
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.-/ 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 City Code and all reporting
requirements...---------=-
Produced ID
Produced ID
Signature of Lobbyist:
Signature of PrindpaljClient:
VI. LOBBYIST IDENTIFICATION:
Form of Identification
~nallY known (Lobbyist) -~
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
~rsonallY known (priRdPal)':~
Si -Qf Public Notary S
Notarization of Lobbyist's
State of Florida, County of Miami-Dade
Swor~,~ subscri~ b~or, me
Thi~'12ay of !l}4cCfI',. 20.{2 Ie
Fl' . natureo~~-~-;;da ..Ii.
g ~Yl'(i. IVETIEPINTO N rization of Principal's signature
W MY COMMISSION #00510978
, EXPIRES: FEB 11, 2010
",,!rei Bonded through 1 st State Insurance
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CLE ' S&-ONLY 2$3/~;") ~
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LL\MARIA-M\LOBBYIST\LOBBYIST FORM 04