Lana Bernstein/Ocean Drive Magazine
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RECE.IVED
CITY CLI!RK'S DEPT.
MtAMIBEACH OCT 262006
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City of Miami Beach Office of the CffiV'~
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.
NAME OF LOBBYIST:
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(Last)
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(First)
(M .I)
t-.A letrY'}, Bead, ,FL
(Zip Code) 33131
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EMAIL:
3D5-5~ - ;)JitDO
FAX NUMBER:
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
O<!.eQY\ \)(l-~ ~~CA1~~
NAME OF PRINCIPAL/CUENT:
f..\lUrrU Bea.d1, FL
63131
lJtea (\ ""Pr; '\t- ).[t(
BUSINESS NAME AND ADDRESS
305- 56 ~ - ~ 5J..fJ.-/
TELEPHONE NUMBER:
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(Number and reet) (City)
-305 -Odd -Q)}..Ko 0
FAX NUMBER: (Optional)
(State)
(Zip Code)
EMAIL: (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 INDIRECfL Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARlNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
e
to be lobbied (Describe in detail):
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. UI:S\,;LU:SUKt: Ut" I t:KM:S ANU AMUUNI:S Ut" LUlnnl:S1 \,;UMt"t:N:SAIIUN lUI:S\,;LU:st: WHt:1 Ht:K HCJUKLY,
FLAT RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required)
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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":
DYes ment or services or on a
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..
DYes iNo: Are YOU reDresentina a not-for-Drofit corDoration or entity without SDecial comDensation
I
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 EXPENDITUR R C PENSATlON DURING THE
REPORTING PERIOD.
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VI. LOBBYIST IDENTIFICATION:
0 Produced 10
Form of Identification
"
0 Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
o Produced 10
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Form of Identification
o Personally known (Principal)
State of Florida, County of Miami-Dade
SW01/il ~d s s ribed before me
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Sign e of Pu ic Notary - State of Florida
Notarization of Lobbyist's signature
Signature 0 Ii 0 ry - State of Florida
Notarization of Principal's signature