Tom Miserendino/AEG Live LLC
.
~
~1iami Be;><h
-
-
2003
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 "LobbyistsR has specific exclusions. Please refer to Ordinance 2004-3435.
Mic::b~Ann;nn
NAME OF LOBBYIST:
(Last)
"'.nm~
(First)
(M.!)
Ca 90036
(Zip Code)
AEG Live LLC
BUSINESS NAME AND ADDRESS
5750 Wilshire Blvd. Sui te 501 Los Anqeles
(Number and Street) (City) (State)
323-930-5711
TELEPHONE NUMBER:
323-930-5797
FAX NUMBER:
tmiserendino@aeqlive.com
EMAlL:
I. LOBBYIST RETAINED BY:
AEG Live LLC
NAME OF PRINOPAL/CLIENT:
AEG Live LLC
BUSINESS NAME AND ADDRESS
5750 Wilshire Blvd. Suite 501
(Number and Street) (City)
Los Angeles
(State)
Ca 90036
(Zip Code)
323-930-5711
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
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:
II. SPECIFIC LOBBY ISSUE:
Jackie Gleason Theatre
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Mayor, City Corrmissionerc N/A
And City Staff
.
,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Part of regular compensation
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Piirt of rQguliir COmp9nSiit ion
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":
~ Yes n No: Are YOU lobbyinG on a Dresent or oendinG bid for GOods. eGuiDment or services. or on a
Dresent or oendinG award for GOods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
,Yes 0 No: Are YOU lobbyinG on a oendinG 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, shall not be required to pay any registration fees..
DYes f No: Are you reDresentinG a not-for-Drofit corDOration or entity without sDecial comDensation
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, LImNG 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 ~UOW; OR rPENSATlON DURING THE
REPORTING PERIOD. /VL~
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 provisions co . eel in Section 482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRlNOPAL IDENTIFICATION:
[J Produced ID
o Produced ID
Form of Identification
Form of Identification
o Personally known (Lobbyist)
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
FOR CLERK'S .uSE ONLY
Annual Registration fee: [v] Yes [ ] No Amount Paid 160 MCR #
Lobbyist Registration Form received and verified by: Y:J..-\L-.€S
F:\CLER\$ALL\MARIA-M\LobbYist\LOBBYIST fORM o~
.d161s:t-Date Paid \6/' e{ 0 lo
Revised 12/08/04
CALIFORNIA JURAT WITH AFFIANT STATEMENT
----:--.-~~~::.::_----~._._._~-~~.
State of California
County of
los ~rJeJ;"
}ss
~See Attached Document (Notary to cross out lines 1-6 below)
o See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary)
Signature of Document Signer No.1
Signature of Document Signer No.2 (if any)
Subscribed and sworn to (or affirmed) before me on this
__ .,';\ <~~.i:h.. ~ ...IIIlIio... ..-. JB... .tIIr... .... ....... Mil... .)
'i~-"-" CRICKETT A. HOFFMAN
~ ' Commission # 1384029 t
Notary Public - California ~
Los Angeles County
My Comm. Expires Nov 9. 2006
{(.,~ day of~, 200<0 , by
Date Month Year
(1) TON\ ~.\S'oeJ\e..V\d~
Name of Signer
o Personally known to me
~ Proved to me on the basis of satisfactory evidence
to be the person who appeared before me (.) (,)
(and
(2) }JJ A
Name of Signer
Place Notary Seal Above
OPTIONAL
Though the information below is not required by law, it may prove
valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document
Further Description of Any Attached Document
RIGHT THUMBPRINT
OF SIGNER #1
RIGHT THUMBPRINT
OF SIGNER #2
Top of thumb here
Top of thumb here
Document Date:
l1<<jl.O~OYI ~IV\
Number of Pages: '2..
Title or Type of Document:OC>~ ~
NIA-
Signer(s) Other Than Named Above:
N!4
.
@2004 Nationat Notary Association' 9350 De Soto Ave., P.O. Box 2402' Chatsworth, CA 91313-2402' www.NationaINotary.org Item #5910 Reorder: Call Toll-Free 1-800-876-6827