Gregory L. Jackson/Miami Dade College
,/ "...,
e MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center DriVe, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means aU persons employed or retained, whether paid or not. by a principal who seeks III encourage tile passage, defeat
or modIfiCation of any ordlnance, resolution, actiOn or decisIOO of any tom_; any action, decision, recommendation Of tile
Oly ~ or any cily board or ..o.....ttee; or any action, decisIOO or recomrnenda\kll of any cily personnel during tile lime
period of tile _ dedsioI~..alcil'9 process on such action, decisIOO or .........,..._ tIlat fCreseeabIy will be heard or revieWed
by tile cily commiSSion, or a cily board or ""....ttee. The lI!rm specifically indudes tile principal as well as any.~ eng;Jged
in lobbying actMties. ,..1!!!J8"" "LubbyIsts" .... spedIIc exd.......... - - '" ClnIInanc:e 2004-3435-
NAMEOFLOB8YISf~QS'K~f' Gr:tPry (~.
M iQ.W\; DCA.Cl. e. Co lIeGe.. 300 t-l€i ~n.l All e. M.i Q."":l 1 fL 33lS 2-
BUSINESS NAME AND ADDRESS ~unm- and Street) (Qly) (Slate) (Zip Code)
(~~NU::.=l" ..)01 0 (~:;~BE~ -=tS6c( ~~C.Ksot\~c:..Gecl,^-
L LOIIIlYISf urAlNED BY:
Ml~\ fY. ~ ~ lleae..
NAME OF PlUNClPAl/Q.IENT: -0
300 f'4€ 2.nA. A;\H.. -:tr 5S01 tvtio.M'l
BUSINESS NAME AND ADDRESS (Number and Street) (Oly)
~u 55
FAX NUMBER: (OptionaQ
-fL
(State)
~3 132.-
~Cod.)
,
EMAlL: (Optional)
flU out this MCtIon If prtnclpal is a CcNporatIon. Parln_lp CII' Trust [Section 2-482 (e))
" NAME OF CHIEF OFFICER, PARlNER, OR BENEFIaARY:
. IDENTlFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN 5lJOi
CORPORATION, PARlNERSHIP OR TRUST:
U. sPE(:l:FIC LOBBY ISSUE: G
C",I+u.C"A.( 6ra.r1~e. O::r-Dg' C~-ty of MiCAMO\i Beo..cl-t Cl.4.L~ { .p~
Issue III be lobbied (DescrIbe In detail):
m. CITY AGENaES/IHDMDUALS TO BE LOBBIED:
A) Full Name or lndIvIdualn-
B) """ Financial, FamUIaI CII' p,.._onaI RelatIonShip
, .
IA\
C. v..lttA.ro..l Ar"is.
/ ....-..,
lV. DISCLOSURE Of 1I!RMS AND AMOUNTS Of LOBBYIST COMPENSAlION (DISCLOSE WHETHER HOURL Y,
RATRATEOR07HEll~ . / ( ,/ ( ,;. L
A) LOBBYISTDlSC\.05URE:(Requlred)~}Z/ p...r+-o A &...lc..r'i
B) PIUNCIPAL'S DISO.OSURE (OF LOBBYIST COMPENSATION): ~Requlred).~ (f2f
11le following Infonnalion must be a.-ered:
1) Pursuant to Miami Beach my Code SectiOn 2-488 Entitled "Prohibited Campaign ContributionS By LobbyistS
on Procurement Issues":
~ ~~=~~.:.==.,,:,=~.._ar--- arana
2) Pursuant '" Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contribullo/lS By LobbyistS On Real
Estate [)eveIopment Issues":
nY..XJta: ~~'::'..:.~-,=.......~!::....~=~=::::r=u:.
MIR1
3) Pursuant to Miami Beach my Code 2-484 (h) Arr( person (except those exempt from the definition of
"lobbyist.'" as set forth in SectiOn 2-481 above) who only appears as a represenlatIVe d a not-for-prollt
rorporation or entity without special oompensatIon or relmbur.;ement for the appearanc;e, whether direct, or
Indirect, to express support of or opposition to any item, shan register with the clerk as required by this
sedion but, shan not be requlred to pay any registration tees..
'j....,.. 0 Na: ArevGU =11II a nat..far-al'lJftl:cr- ar---I.., mm_an
or ralmbur'tl8ment. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 15f OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO 11tE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5TlNG LOBBYING EXPENDITURES, AS WEU. AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR r3:ING ~A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO RES OR DURING THE
REPQRnNG PERIOD. /
. ~ "'tA----
I do solemnly swear that all of the foregoing facts are true and oorrect and that I have read or am
familiar with the proIIlsionSQ: In SectI 2 of the Miami Beadl City Code and all reporting
requirements.
Signature of lobbyist:'
Signature of Prlnclpal/Olent:
VI. LOIIIlYISf lOEfl'I1flCA1IDN:
PlIINCIPAL IDEN1IFICAlION:
o Produced 10
o Produced ID
Form of Identification
Form of IdentlficaliOn
,; Personally known (LobbyIst)
YD. SIGNATURE AND STAMP OF NOTARY:
State af FlorIda, CountY af Miami-
SWorn to and subscrtbed before me
This ~ b7b'V""""', 2
SlgnatUre d PubUc NoIllry -
Nub. Il.atIOn of ~ist's s\gnlIlure
o I'eI9lI1aIIy known (Principal)
nty d Miaml-Oade
before me
20_
Notary State of florida
ndpaI's signature
Revised 12108/04
O~ft \6;feM