Son Truong/Rosa Martinez
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MIAMI BEACH
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 during the time
period of the entire decision-making process on sum 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.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street)
(... D$ Co2-D -7781
\:nLEPHO E NUMBER:
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(~te) I (Zip CcXle)
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CUENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
305- ~tt3' Det"7"
TELEPHONE NUMBER:
1'\\A\Y\l . &~
(City)
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(State)
33 14-l
(Zip Code)
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:
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Issue to be lobbied (Describe in detail):
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III. 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 RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~.5 /h.t'
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ..$"lS"" )~...
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":
D Yes J No: Are you lobbvina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a
Dresent or Dendina 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 ri No: 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..
DYes rJ No: Are yOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation
or reimbursement.
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 EXPENDITURES OR COMPENSATION DURING THE
REPORTlNG PERIOD. ~ 70;?>
Signature of Lo st
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.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~NCIPALIDE~ON~
ilWroduced ID
Form of Identification
1.f?3 5-..,-JP-49. 7/ f-O
o Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 5 day of V 20(2b
State of Florida, County of Miami-Dade
Sworn and subscri before me
This ~day of
Date Paid
[J Produced ID
Form of Identification
~Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
o Public Notary - State of Florida
on of Lobbyist's signature
FOR CLE
Annual Registration fee: [l/fYes [ ] No Amount
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYlST fORM OS.
'SSllS[ON~R# ;.g1/0 (
Revised 12/08/04