Ava Radd-Harte/Center for Emerging Art, Inc.
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MIAMI BEACH
City of Miami Beach Office of thJI~!nf~fk7
1700 Convention Center Drive, Miami Beach,cFi~~3C-e~Rf\'S OFF ICE
RECtlVED
AM II: 11
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.
RN){)'- +)ARTE A vA- L .
NAME OF LOBBYIST: (Last) ~ (First) (M.!)
CENTer< 10K ~ 11y1F Rei N~ ART} J(\JC
BUSINESS NAME AND ADD~~S~ . \ (Nu er and Street) (City) (State~ /' (Zip Code)
~VD \NQ$ r ,-::t' i !X'~\ '-L S31 39
TELEPHONE NUMBER: --- --:l C (YFAX NUMBER: ^ I EMAIL: 'R"' I.. ..i' . J .
I. -'bL~~;'R;~~;,t6D3~ IV cUlDqy) !O. edl
C ~ ~ '\ ( .(.A.-J
NAME OF PRINCIPAljCLIENT:
c ~
. >^v
BUSINESS NAME AND ADDRESS (Number and Street)
(City)
(State)
(Zip Code)
TELEPHONE NUMBER:
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.
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/lAMA~--t
. -0 ~
~
UI. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
1JA
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(1) C'l 0 ~
.c \.0 C'l III ~
C ~ g ~ Personally known (Lobbyist)
'(j) Cl '- ~
'5 ;; ~i VII. SIGNATURE AND STAMP OF NOTARY:
en c ~ 'S
.0 a::;"
.., 'in Cl ;- State of Florida, County of Miami-Dade
fA ~
~ 'E :3~. Swor~to ~>?Ubscri~fore me . '7
;:j E'i:i!. This -day oft. , 20g
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATI N (DISCLOSE WHETHER HOVRL Y,
FLA T RA TE OR OTHER): /
"
A) LOBBYIST DISCLOSURE: (Required)
:l-
The following information must be answered:
..--1....-
-.-/
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On P curement Issues":
DYes ment or services or on a
2) Pur uant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Es te 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..
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 COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CA D R. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES C SATION DURING THE
REPORTING PERIOD.
familiar with the provisions contained
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
true and correct and that I have read or am
of the Miami Beach City Code and all reporting
/'
VI. LOBBYIST IDENTIFICATION:
D Produced ID
U Produced ID
Form of Identification
Form of Identification
~rSOnalIY known (Principal)
FOR LER '
Annual Registration fee: [ ] Yes [ ] No A~un P 'd
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARlA-M\Lobbyist\LOBBYIST fORM oc
Date Paid " :..J.. 7 -{) ')
Revised 12/08/04
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