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James Rauh/National Parking Corp. tD ,.,. 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 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 spedfie exclusions. Please refer to Ordinance 2004-3435. ?~H ~,,",~J (Last) (First) ~( "<- ~ "7 e,-v.,,..,) C (Number and Street) (G, NAME OF LOBBYIST: ){o5- -/ BUSINESS NAME AND ADDRESS i....... J Tk<:> /VI '",.-vV' I (City) .s~3'-'l-c.. 11-- t:c.. (M.I) s 1'?7 (Zip Code) (State) '5 dr; 5"' 3 (/ LI -,!:' /> TELEPHONE NUMBER: ? ~r !; -Sf; S 50 L( FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: N A-ri<l..-v __ f1rk h. (,-</ "- NAME OF PRINCIPAL/CLIENT: ( 0,-</. ;tJ A-- r 1 ~,,... """- BUSINESS NAME AND ADDRESS G,; S ;-A S.Iv,~ (City) p Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)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: D. SPECIFIC LOBBY ISSUE: ?/;t.jq',v LtJ r Issue to.be lobbied (Desc e in detail): / ,..-,,-;-- b /r--.,J S I 'i f( 0 U 11../ Ii.. ~ 11 t/ /f' L DI. CITY AGENCIEs/INDMDUALs TO BE LOBBIED: A) Full Name of Individual/ntle B) Any Financial, Familial or Professional Relationship j;?, fS: L'J J't ~ (') . L./fNAlIN (. !\JD IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FlA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) .$ g tWo c:-:... The following information must be answered: B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ,(Required), 1) jJ SCUJ. 0,) 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes 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 5IfALL BE FILED EVEN IF THERE HAVE BEEN ND EXP U~PE:nON DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing familiar with the provisions c "ned in Se . n requirements. Signature of Lobbyist: VI. ~. P I LOBBYIST IDENTIFICATION: ~Produced ID I"..,~ I~ h Form of Identification fl( rJ &0 n 4cn"- '1<-t - '3 '-f 9- 0 o Personally known (Lobbyist) Signature of Principal/Cr YZ- - VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade ~~rn~o~~s~bscribed ~~~:,ce20~& If: "',~:~<~1~~:,~~~,:~~;~;r~~~rf S gnature . ,', >.;. \:C)~~~:.~19~:c'i: !~ Notarization., tObbyi$t"ssignature,. , .,... ... .~;, :n':',?l"~'"~.l/>:0;~", :""~l'i ~:__':~':'i' -,:~;::_~;;:;'~;J:7';:i';<;~, ~A:;-.:,:;~;~~:,_,j,,~:~,:. :~;:~.~ e true and correct and that I have read or am -482 of the Miami Beach City Code and all reporting PRINCIPAL IDENTIFICATION: ~oduced ID ~ ~ Form. of Jdentific.ation -;> '7J - I 1 S S-;;l. ::J. - 73 v-..) & -.) -L/ o Personally known (Principal) State of Florida, County of Miami-Dade Sworn a!19 SUbscribed. .,. This 2J:!2day of J?t ~~ ' Signature of u' lic No Notarization of Principal's signature FOR CLER!5.~~ Annual Registration fee: ] Yes [ ] No AmounU'aJc:I ' MCR # Lobbyist Registration Form received and verified bY&dc."'lI\eD ' ., F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM . oc Date Paid Revised 12/08/04