John K. Shubin/Mr. Dean Stratouly
e MIAMtBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, Fl33139
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 dty commission, or a my board or committee. The term specificaUy includes the principal as wen as any employee engaged
in lobbying activities. The term "lobbyists' has specific exdusions. 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) (Oty) (S~te)
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TELEPHONE NUMBER: FAX NUMBER:
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(ZipCode) '33130
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I. LOBBYIST RETAINED BY:
NAME Of1l::;~:; ~ g~ ~ \) 'J
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BUSINESS NAME AND ADDRESS (Number and Street)
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TELEPHONE NUMBER:
Fill out this section if principal is a Corporation, PartnerShip or Trust [SectIon 2-482 (e))
.
NAME OF OtIEF OFFICER, PARTNER, OR BENEFICIARY: 1)E: A-I\.i S~A;-, OV L- 'i
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: D~AN 5 Tl<:...A-T 00 L./
.
II.
SPECIFIC LOBBY ISSUE:
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A) Full Name of IndiVidual/Title
B} Any Anandal, FamiHal or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYISTCOMPENSAUON (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISClOSURE: (Required) $ "SO f'''" ~~..
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CDMPENSATION): (ReqUired). I c.t50 .."r ......,...
The following Information must be answered:
1) Pursuant to Miami Beach my Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
on Procurement Issues":
o Yes~: Are YOU IobbYina on a oresent or aendina bid for GOOds. eauimnent or services. or on a
';~t or aendina award for GOOds. eauiDment or service?
2) Pursuant to Miami Beach Oty Code 2.-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
oYes~No: A=~:n~:;:~=~the~or
I Ii r ;;;;~ ;;;;~~-';cdIOn or chanae to the CitY's Future Land Use
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3) Pursuant to Miami Beach Oty 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 dired, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shaD not be required to pay any registration fees..
o Yes~: Are ~ =na a not-for-orofit corooration or entity without soecial comDellSation
or relmbb~ .
v. SIGNATURE UNDER OATH:
ON OCTOBER lsr OF EACH YEAR, EACH LOBBYISf SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDllURE5, 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 EXPENDllURES OR COMPENSATION DURING THE
REPORTING PERIOD.
~~~~~
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 contai . 2 f the Miami BeaCh . Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTlFICAUON:
o Produced 10
State of Florida, Coun
Sworn and subscribed
This _day of
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Signature of Public Notary - State of Aorida .
Notarization of Prindpal's signature
Form of Identification
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VII. SIGNATURE AND .
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State of Aorida, County of ~~II8IlUIi~.~~
Sworn ~AK1 subscribed ~me !!T';.D<1f \ ~ i
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Annual Registration fee: Yes [ ] No
Lobbyist Registration Form received and verified by'
F:\CLER\$ALL\MARIA-M\lobbyist\LOBBYIST roR 5.
~~p f3J!3.3 Date Paid
R! viSed 12/08/04