Howard Herring/New World Symphony
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 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 specifically indudes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has spedfic exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
1-1 DWo.y' r-J
(First)
(M .I)
3 t <J
(Zip Code)
~. ec:Pc.{
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CUENT:
.3(39
(Zip Code)
.305-(0 7~- -3.3.30
TELEPHONE NUMBER:
.3oS-to"B -Scf'03
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:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
~trr'oI ~~t..{)~
Issue to be lobbied (Describ In d tail):
(~u.. '\ .e~ t'\.I1.~i tI"\'\ fY[j'~~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
S".s '~Vl fl'
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
I' FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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"" No: Are you lobbvina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a
Dresent or oendina award for aoods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes )lNO: Are you lobbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use
MaD?
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 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 EX..wITURES OR CO PENSA. TION DURING THE
REPORTING PERIOD.
\
Signatu 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 i Section 2-482 of he Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
D Produced ID
D Produced ID
VI. LOBBYIST IDENTIFICATION:
Form of Identification
Form of Identification
~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
c(Personally known (Principal)
~J\, Tem Inook
'~; MyODmml.llonDD1_
~ ..,.'1 Ellpll'H AprIl 2". 'JtJ1f
State of Florida, County of Miami-Dade
Sworn and subscrib d before me
This ...2&-day of O~
,
Signature of uti ic Notary - State of Florida
Notarization of Lobbyist's signature
Signatur uti IC Nota - State of Florida
Notarization of Principal's signature
~I\. ~ . FOR CLE
Annual Registration fee: [ ] Y, ] No Amount Paid
Lobbyist Registration Form r~ived and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 .
#bf(A
I
Date"lllid I.D /2/ Of?
Revised 12/08/04