Amy E. Huber
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.(9- MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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 dty personnel during the time
period of the entire decision-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a dty board or committee. The term specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The tenn "Lobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
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(Number and Street) (City)
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(State) (Zip Code)
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EMAIL:
NAME OF LOBBYIST:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CUENT: /
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BUSINESS NAME AND ADDRESS (NO' ,od S_) caty) (State) C"p Code)
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEf.:ESCER PARTNER, OR BENEFICIARY:
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· IDENTIFY ALL PERSONS H DING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUAL5 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):
A) LOBBYIST DISCLOSURE: (Required) ~ 11~. 00 } ~4l .
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION/(ReqUired). ~ 'TS I hrv
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 ment or services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes
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..
DYes
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 EXPENDITU ES 0 CO PENSATION DURING THE
REPORTING PERIOD.
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 co tained i Se tion 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
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Form of Identif~~~.:;~ISsiQ..;t~~
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ersonally known (Principallf /$ ~~'i '.?Oqp~'" ~
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State of Flonda, County of Mlam~~l!.;.<;>:?-101}c1edi\1I'" .\Of' .,' ::.~
Sworn and subscrib d before me ~~4~..VbliC Ur(\e~~~~'.", ,::.'
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ThiS ...LI--day of ~ 20-:''IQ'III~/C. 87 ATE 0' \/.,
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~\\\"tI"mClnature of Principal/Client:
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~~ '>.<O~\..."".N ~~OBBYIST. IDENTIFICATION:
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i /; 4' ~<Jl ~ '* i Form of Identification
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S '* ~ 43fI:AO. ~~nally known (Lobbyist)
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~v/'...%I"Il80ndel\\~..~.~NATURE AND STAMP OF NOTARY:
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'/11/1, UtlLiC, 3S~\~~r Florida, County of Miami-Dade
'"f/lflll\\~'Orn\tp ~d sUbscrib~e
This' day of , 200b
State of Florida
s signature
FOR CLERK'S USE ONLY <' .
Annual Registration fee: -p<J Yes [ ] No Amoun~. MCR # ~~~
Lobbyist Registration Form received and verified ~~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM . c
Date Paid ~ ra/::::XP
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Revised 12/08/04