Alet Thierry
~
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 dty 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 dty board or committee. The tenn specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyists- has specific exclusions. Please refer to Ordinance 2004-3435.
T*,ia~ y
NAME OF LOBBYIST:
A-LeT
(Last)
~{iaC 1J./D.lEPe:N.PeNr /Vew- YOIZK
BUSINESS NAME AND ADDRESS (Number and Street)
(Zn) ~ 05 1'1
TELEPHONE NUMBER:
(Rrst)
(M.!)
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(State) (Zip Code)
TT+i E:fJ.Ry ~ pj VA-FA-i ~ . CI!J fV)
EMAIL:
(aty)
FAX NUMBER:
I. LOBBYIST RETAINED BY:
T+t" e:Rey A-teT
NAME OF PRINQPAljCLlENT:
~ IWe:pe7VPe;l./I
BUSINESS NAME AND ADDRESS (Number and Street)
>ve:w 'tOfl..fL }J'-f - (Dot (
(aty) (State) (Zip Code)
{;,?6 ~/g Zo ift'tQf<..Y @Div,4-Fftf2..(jJ1l
FAX NUMBER: (Optional) EMAIL: (Optional)
'kt2. GOlf 05/Q
TELEPHONE NUMBER:
fill out this section if prindpal is a COrporation, Partnership or Trust [Section 2-482 (e)]
. 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:
D. SPECIFIC LOBBY ISSUE:
VL:A !Cf2/YNT
Issue to be lobbied (Describe in detail):
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ell ~ 'j t'-J
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1)\ if A: FA1'(2-
m.
CITY AGENClES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
VC--A
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) t 0
B) PRINQPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired)._$- (')
The following information must be answered:
1) Pursuant to Miami Beach aty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes ~rJO: Are YOU lobbvina on a oresent or oendinG bid for Goods. eauiDment or services. or on a
DreSent or oendina award for Goods. eauimnent or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are YOU lobbYinG on a oendinG aDDlication for a Develooment AGreement with the ~ :;
aDDlicatiqp'l for chanGe of zoninG maD desianatio", or chanae to the City's Future Land Use
MIDl
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 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..
'Ii Yes D No: Are YOU reoresentina a notoofor-orofit corooration or entity without soedal comoensation
, or reimbursement. .
V. SIGNAlURE UNDER OAnt:
ON OCTOBER 151 OF EACH YEAR, EACH LOBBYISf SHALL SUBMIT TO THE CITY CLERK A SIGNED
SfATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE ED CALENDAR YEAR. A :rEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN OR COMPENSAnON NG THE
REPORnNG PERIOD.
VI.
ID8BYJST'1;;("f1<""
~oduced ID 0 ~ V F (, 7Y-S ~
Fonn of Identification
PRINCIPAL IDENltFlCATION:
a-PfOduced ID ~ ~ 'J J/ y= ~ 7 fS-j
Forfn of Identification
I do SOlemnly swear that all of the fo~
familiar with the provisions contained .
requirements.
Signature of Lobbyist:
Signature of Principal/Oient:
D Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
o Personally known (Principal)
State of Aorida, County of Miami-Dade
SWO}bscribed before me
This yof ".. . .. "!')!~'J"
.,~o.\ ... ~J'- KERRY HEmm.m:z
/ .'*:' / MY COMM!?SION It DO 175-:9; I~
Signa of Pu . N - '::" ,'" '. .' ~~~iY ~;"";~'u~':'~\ri!0".,s.jf
Notarization Pri ~,~~.~~,~"'t!'~'it'~~~~~1
O't.lt!
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Date Paid 0l.A/ ~
Revised 12/08/04