John Shawde/AEG Live, LLC
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MIAMIBEACH
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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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(Last) (First) (M.!)
V" t'Vlt:lv\ ~oO S. bl~l.c::t t'\L ~l"t:> ~ 1000 Ml~~" Pz-- '!>'!J'31
(Number and Street) (City) (State) (Zip Code)
,?>o5 '1 \\f 43~o J 5~Gl",dLe Ge(~n).",~<<."}1,,t"I. (O~
FAX NUMBER: EMAIL:
.? 2-'; 1:;0,5111
TELEPHONE NUMBER:
S\A.,tfl 50!
(N umber and Stree )
~2..~ "';0-' 5112-
FAX NUMBER: (Optional)
(J\
C\OO~lo
(State)
(Zip Code)
5150 \U"~,^IrL 0\"()
BUSINESS NAME AND ADDRESS
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFIi:fR" PARTNER, OR BENEFICIARy:124~t:>~ ~h,\ \ If5, t>r(..~l ~L..vl+
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCfi.
CORPORATION, PARTNERSHIP OR TRUST: "S-Cj l\\1t Ll..C. IS <..o'^'t..o\I*"c> '3~ ^f\Sc.~tz- .E..'I1<<.rto'......c
will,,'" ,~ o~"H'6 4"'(:) c~'h"o\ll!r:::. '3j T~c. AhSc..hv..-\"2-. ~"""P"""",j wn'c..~ l~ 100010
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II. SPECIFIC LOBBY ISSUE: I \..J r '''J \.:'J
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Issue to be lobbied (Describe in detail):
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III. CITY AGENCIES/INDIVIDUALS TO BE lOBBIED:
A) Full Name of Individual/Title
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Ket~or o.V\i;> C.lry CO"\l\~I\.~IO"~t'~
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF lOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOR OTHER):
A) LOBBYIST DISCLOSURE: (Required) j; ~ t 5' ttf
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":
~es D No: Are you lobbvina on a oresent or oendina bid for aoods. eauioment or services. or on a
present or oendina award for aoods. eauiDment 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 lobbvina on a oendina aoolication for a Develooment Aareement with the City or
aoolication for chanae of zonina mao desionation or chanae to the City's Future Land Use
Mao?
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..
D Yes ~o: Are you reoresentina a not-for-orofit corDoration or entity without soecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SU , T TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXP DI RES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE R QIN LENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E EN R COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the for~ing f s e true and correct and that I have read or am
familiar with the provisions contained iy( SI=! 2- 2 he Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
D Produced ID
PRI~IPAL IDENTIFICATION:
~oduced ID ~ ai/ f<< it; IA. b L ,t .,f 17' -33/ 3
Form of Identification
VI. LOBBYIST IDENTIFICATION:
Form of Identification
~rSOnallY known (Lobbyist)
o Personally known (Principal)
AMP OF NOTARY:
FOR CLERK'S USE 2I'IL Y (jC
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Lobbyist Registration Form received and verified by:
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Date Paid
Revised 12/08/04