Ellen Jameson/All Dimension of South Beach
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MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
WBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a p1indpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedsion, recommendation of the
City Manager or any dty board or committee; or any action, dedsion or recommendation of any dty personnel during the time
period of the entire dedsion-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a dty board or committee. The term spedfically indudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyim- has specific exdusions. Please refer to Ordinance 2004-3435.
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TELEPHONE NUMBER:
~A"(GSoN CLLtE"N
(Last) (Rrst) (M.I)
() F- 50lA-'nt 8€'Ac:-~, NINE /5U4NO 1t1Je- #.ro2, FC3s13'1
(Number and Street) (Oty) (State)' (Zip Code)
sc> s- - 6 cr S- - 0 lOb ell P-4U- ~ e..--? "'^ <:2:L &rJ( SOLA It i> ~
FAX NUMBER: ~
NAME OF LOBBYIST:
4 ~~ j),. fA, Q.I'\S iON
BUSINESS NAME AND ADDRESS
L LOBBYIST RETAINED BY:
4 ~ j) '" M ~ / c.N'" or ~OIAVl gec-r-k
NAME OF PRINOPAl/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street)
~ i~' @,e.c-..d-
(City)
(C
(State)
3.SL$'1'
(Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
'SO S -84-1 _ z- ,91 30S"" - 6'1S' -0,0 b ell c.+t~~ c:a
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
( JOvJ-L 0 ^J:.
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
D. SPEaFIe LOBBY ISSUE:
G-IZ-AN T - 11 B c t.J....h.revl t4Yk Co l-'\.c...' L
Issue to be lobbied (Describe in detail):
m. CITY AGENaES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
HB CLAL~ Art:; LoL/\c:.....C
)
IV. DIsCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOUR! Y,
FLAT RATE OR 071lER).
A) LOBBYIST DISCLOSURE: (Required)
B) PRlNOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach Oty Code Section 2-488 Entitled "Prohibited Campaign Conbibutions By Lobbyists
On Procurement Issues":
c)
o
D Yes 'lYINo: Are vou lobbYinG on a Dresent or oendinG bid for GOOds. eauiDment or services. or on a
Dresent or oendinG award for Goods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Conbibutions By Lobbyists On Real
Estate Development Issues":
DYes )r( No: Are vou lobbYinG on a oendinG aDDlication for a DeveloDment AGreement with the City or
aDoIication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use
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3) Pursuant to Miami Beach Oty 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 derlc as required by this
section but, shall not be required to pay any registration fees..
~es D No: Are vou reoresentinG a not-for-Drafit corooration or entitY without soecial comoensation
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, LI5TING 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 EXPENDITURES OR COMPENSAnON DURING THE
REPORnNG PERIOD.
fQ~ :r ~~
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of principal/Client:WO ~
~
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,
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VI.
LOBBYlSTID~n~N: .
~UcedID ~ ~
Fonn of IdentifICation
PRINaPAL IDENTIFICAnON:
~ID ~ ~
Fonn of Identification
D Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
D Personally known (Principal)
State of Ronda, Cou
Swom....w4 subscri
This ~da of
Florida
. n of Lobbyist's signature
Annual Registration fee: [ ] Yes
Date Paid
Revised 12/08/04