Donna Zemo/iami Beach Chamber of Commerce
tD
......
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 ord:nance, 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 d 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.
NAME OF LOBBYIST:
L.evv\n UOV'\rA
: (La~t) ! (Fi~),. . (M.I) (Yl. 6.,
1\...\\rAVVv( 6tet ct, t)\(:;-.>\ +0\11 C~J\r\1t~~ ~31 ~C;
(Number and Street) (City) (State)
O~ 6?J'~"
FAX NUMBER:
( ip Code)
IJt\b-er. WlM
,BUSINESS NAME AND ADDRESS
(30Gl f..o7 ~-I d../O
\:j=ELEPHONE NUMBER:
LOBBYIST RETAINED BY:
J..\;\ ~vw:..' ~O fA elk
NAME OF PRINCIPAL/CLIENT:
t~ e,A/\~\All';l\ f\A..ut.
(City)
I.
C.l~jVIt..~/")
o{)
C~)N'V\ YV()N'C.L-.-
(Number and Street)
(State)
2J'~l ~~l
(Zip Code)
~ ,(iLe)
BUSINESS NAME AND ADDRESS
tlt~. f=-"c,
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
.
NAME OF CHIEF OFFICER, PARTNER, OR BEN~FICIARY~ . J" Jl
W!uV\~ o\L.~~"'v-4 - \~~:\tC\JL,1L\
IDENTIFY ALL~~;StINS HOLDING, DIRblY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PAR"-~IERSHIP OR TRUST:
.
II.
SPECIFIC LOBBY IS;;
~ IV
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individ ual/Title B) Any Financial, Familial or Professional Relationship
(.) C A
-
IV. DISCLOSURE Of TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FlA T RA TE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) ~ 0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).---J0 r-j
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":
o Yes)tNo: Are you lobbving on a Dresent or Dending bid for goods. eauiDment or selVices. or on a
Dresent or Dending award for goods. egUiDment or selVice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Developmer,t Issues":
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..
ion
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
REPORTING PERIOD. ~" . . ~
)NJL 0 ~I")
. · 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 provisio ontained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. !
Signature of Lobbyist:
Signature of principal/Cllent:C
VI. LOBBYIST IDENTIl'ICATIO
~duced ID ~ ~
Form of Identification
11'" /), "
[~oduced ID ~ ~
Form of Identification
o Personally known (Lobbyist)
i] Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Annual Registration fee: [ ] Yes [ ] No
Lobbyist Registration Form received and verified
F:\CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fOR
Revised 12/08/04