Wendy Kallergis/Miami Beach Visitors Center and Chamber of Commerce
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MIAMIBEACH
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City of Miami Beach Office o! th~ qt}' per~
1700 Convention Center Drive, Miai)ij ~chi Fit ,33'13~....
LOBBYIST REGISTRA TI()~)'ORM':
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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, dedsion or recommendation that foreseeably will be heard or reviewed
by the city commission, or a cit:y board or committee. The term specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The tenn "Lobbyists" has specifie exclusions. Please refer to Ordinance 2004-3435.
\(<.Lasto..) \ \ e V' qr-ts, (FI""rst)
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BUSINESS NAM~ AND ADDR~i'- (Number and Street) (City) (State) (Zip Code) 33\34
(~o.;:J (oq 5-:~ ~a ~ ~O~) ,-S~8-t.l33Co W. \{A \\{;"R.&\~ (0) vY1A~
~LEPHONE NUMBER: FAX . MBER: EMAIL: bQll ~~
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NAME OF PRINCIPAL/CLIEi\jT: ~
19dO H~ &e. Uam &acl 'dQ. 33l:/1
BUSINESS NAME AND AD[IRESS (Number and Street) (City) (State) (Zip Code)
~H~;NU0E:d..:-ld7Q ~~L~~,)1?--<07ro (E~t~o~ ~)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)]
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Wl.1\1\/D ~~, bL 1'1 ~ D IIJ.,~
IDENTIFY ALLPEl~S HOt~ ~R-I~m~ECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
.
II.
III. CITY AGENCIES/INDMDUALS T BE LOBBIED:
A) Full Name of Individual/"!1t1e
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RATE OR OTHER):
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A) LOBBYIST DISCLOSURE: (R.equired)
B) PRINCIPAL'S DISCLOSURE;OF LOBBYIST COMPENSATION): (Required).
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 ~o: Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGuiDment or services. or on a
Dresent or DendinG award for Goods. eGuiDment 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 DendinG aDDlication for a DeyeloDment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe 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, st'lll not be required to pay any registration fees..
lX)~ C(,UtJl(U~
gnature 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 provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
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Signature of Lobbyist: __ C ,
'~ ~Slgnature of Principal/aienl: .. ~
lfl,.,P'foduced 10 ~ ~ [j. roduced 10 ~ ~
Form orIdentification Form of Identification
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.
o Personally known (Lobbyist)
LJ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
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Annual Istra ion f : [ ] Yes [ No Amount Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lob':>yi;t\LOBBYIST fORM 0
mF(T ~aid &\* \31 <0
Revised 12/08/04