Alexander Heckler/Miami Beach Residents for Homeowners Rights
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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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NAME OF LOBBYIST: (Last) (First) (M.!)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (ZIp Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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(Number and Street) (City)
7 V '7 j-
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(State)
35/"3 j
BUSINESS NAME AND ADDRESS
~6~- {'77
TELEPHONE NUMBER:
(Zip Code)
FAX NUMBER: (Optional)
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 INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE: .. ;j
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name ofIndividual/Title B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER): t
A) LOBBYIST DISCLOSURE: (Required) f /80 - ~ ~ C..) (>"'--r f-, CA.N (' t\ ry'
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required),
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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
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
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBY ST S
STATEMENT UNDER OATH, LISTING LOBBYIN E
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE
SHALL BE FILED EVEN IF THERE HAVE BEEN N EXP
REPORTING PERIOD.
ure of Lobbyist
I do solemnly swear that al f the foregOin~acts7 re true and correct and that I have read or am
famil.iar with the provision co aj~ i~ Sectj n 2- of the Miami Beach City Code and all reporting
reqUirements. y
Signature of Lobbyist: - "- -', '-~ t-
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Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
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Form of Identification
PR[N~,"EN~ '
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Form of Identification
o Personally known (Lobbyist)
[' Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to sllJd su
This / C?!J d
/"" FOR CLER~S&9NL Y ti
Annual Registration fee: [ \...1'1es [ ] No Amount Paid ~R # ~ Date Paid lJ I tJJ vr
Lobbyist Registration Form received and verified b~ ~~1
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM , c Revised 12/08/04