Susan Besu/New Florida Properties Corp.
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MIAMIBEACH
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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 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 includes the principal as well as any employee engaged
in lobbying activities, The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) - (Fir~
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State).J
(3o S) :S~b -I (1&
TELEPHONE NUMBER:
1305 )
FAX NUMBER:
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(Zip Code) .3~ I ~ (
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCI AL/CLIENT:
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BUSINESS NAME AND ADDRESS
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(Number and Street) (City) (State)
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FAX NUMBER: (Optional) EMAIL: (Optional)
17 ..:33r 7'eJ
(Zip Code)
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TELEPHONE NUMBER:
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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IDENTIFY ALL PERSONS HOLDING, 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):
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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 HOURLY,
FLAT RA TE OR OTHER): /
A) LOBBYIST DISCLOSURE: (Required) Cl{ Ip h .ae-L1
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~eqUired), 61/ )5/ ku.-1-
/
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 D No: Are YOU lobbyinc on a oresent or oendinc bid for coods, ecuioment or services, or on a
oresent or oendinc award for coods, eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes D No: Are YOU lobbyinc on a oendinc aoolication for a Develooment Acreement with the City or
aoolication for chance of zoninc mao desicnation or chance to the City's Future Land Use
Mao?
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 D No: Are YOU reoresentinc a not-for-orofit corooration or entity without soecial comoensation
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 R OMPENSATION DURING THE
REPORTING PERIOD.
ue and correct and that I have read or am
the Miami Beach City Code and all reporting
I do solemnly swear that all of the foregoing fa
familiar with the provisions contained in Section -
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
i Produced ID
Form of Identification Form of Identification
c(J Personally known (Lobbyist) ~~ :';'=:G.1Dm (Principal)
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VII. SIGNATURE AND STAMP OF NOTARY:
Signatu e of . Notary - State of Florida
Notarization of Principal's signature
FORC
Annual Registration fee: [ Yes [ ] No Am un
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05 oc
ONLY /Jf r
MCR tt2l- 1/ U ;;2Date Paid
Revised 12/08/04
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07-19-06 03:26PM
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FROM-TEW CARDENAS REBAK
+3055361116
T-097 P.02/03 F-287
.- tv. DISCLOSURi OF TERMS AND A"'OUNTS Of L088YlST COMPE~SATION (DISCI-OSE WHETHER HOURLY,
FLA T RA TE OR OTHER).
A} LOB8YIST DISCLOSURE: (RlI!quired)
8} PRlNCIPAL'S DISCLOSURE (OF LOBBYISi COMPENSATION): (Required),
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The following information must be answered:
1) Pursuant to Miami BeClch City Code Section 2-488 Entitled "Prohlbiteo Campaign Contributions By Lobbyists
On j:lrocurement Issues":
DYes iI No: Are yOU lobbyina on a "resent or Dending bid for goods, eGuioment or services, or on a
DLesent or pendinQ award for aoods. equipment Or service?
2) Pursuant to Miami Beach City Code 2-<190 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues";
nyes 0 No: Are you lobbving on a DendinQ applialtion for a Develoornent AGreement with the City or
applica,!ion for change of zoninq map desiGnation or change to the City's Future Land Use
Mmtl
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" CIS set forth in Section l-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..
n Yes 0 No: Aruol.l re9resenting a not-for-profit corooration or entity without special comDensatio,D
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 SY 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 R OMPENSAYlON DURING THE
REPORTING PERIOD.
ue and correct and that I have read or am
the Miami Beach City Code and all reporting
I do solemnly swear that all of the foregoing fa
familiar with the provisions contained in Section -
requirements.
Signature of Lobbyist: _
Signature of Principal/Client -~eJ.tt/
/ c::AolSlJ"~ To N FLOP<<.IP'A
VI. LOSIIYIST IDENTIFICATION: ~ P C! L I NTlFICATION:
(Jroduced ID bit. W 2-";t..a t~<t.aR
Form of Identification F Form of IdentificCltion
1/) EIizIlloIh Bmm;vgg
(J Personally known (lobbvist) . ... ~i My~_G:l_m (Principal)
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SIGNATURE AND STAMP OF NOTARY:
Produced ID
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VII.
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FOR CLERK'S USE,ONLY
Annl.lal Regist(ation fee: ( ] Yes [ ) No Amount Paid MeR #
l-Obbyi:;t Regisuatlon Form received and verified by:
F:\CI.J~R\~ALL\f>'1AR!A.M\Lobbyist\lOB8Yl~T fbRM 05.doc
Oare Paid
Revised l2/08/04