Steven Marin/Consul-tech Enterprises
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MIAMI BEACH
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City of Mic:lmi Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA T10NFORM
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 dty commission, or a city board' or committee. The term spedfictllly indudes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exdusions. Please refer to Ordinance 2004-3435.
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(First)
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BUSINESS NAME AND ADDRESS (Number and Street) (aty)
~S_ '111.14-22 !:lOS. 07 !.34 U
TELEPHONE NUMBER: FAX NUMBER: '
NAME OF LOBBYIST:
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(Last) ,
(M.!)
IV)', CU'~"I 1 Fi 33/71
(State) (Zip Code)
SM @/'YY,frlll IJ Yl4 JDJI}J. Co l'Y\
EMAIL:
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BUSINESS NAME AND ADDRESS ' (Number and Street) (City)
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TELEPHONE NUMBER:
LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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(State) (Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
---.. .. f".indpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
.. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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.... IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
&f402.~~ J4A.tJ;./A,fJl-/~&i"~ ~A-JZ6~T"d.
II. SPECIFIC LOBBY ISSUE:
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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III
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IV. DISCLOSURE OF TERMS AND AMOUNTS".:fF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISQ.OSUR" (Requl..d) -# j, ~1"~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI '): (Required).---=Itr:COD" ~ 1"f"'D"~
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1)
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2, Artide VII Division 5
thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv 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
REPOIUING 'ERIOO. ~ _....
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c::::...,/ 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.
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Signature of Lobbyist:
Signature of Prindpal/Client:
VI. LOBBYIST IDENTIFICATION:~
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PRINCPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
~rsonallY known (Lobbyist)
Form of Identification
~Of1aIlY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swor~(!e,and SUbsaib~~~ ~e
This ~day of 2~ce
State of Florida, County of Miami-Dade
S~OJflHl~bscri befor e re
Thl~aay of 20-fl
;/
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otary Sta ida
5 signature
FOR C ~
Annual Registration fee: ] Yes [ ] No Amount '
Lobbyist Registration Form received and verified by:
Revised 02/10/04
ONLY ",~ 2171'
M~Datepaid
\MARIA-M\LOBBYIST\LOBBYIST FORM 04
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