Sally Gibson/Vallejo Gantner
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....
MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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.
LOBBYIST REGISTRATION FORM
NAME OF LOBBYIST:
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BUSINESS NAME AND ADDRESS
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(Last)
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(First)
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(Number and Street) (City) (State)
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FAX NUMBER:
(M.I)
(Zip Code)
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tot..
I, LOBBYIST RETAINED BY:
A '-L-E:jo
NAME OF PRINCIPAl/CLIENT:
~ J'J"rN~~
~ It GL. LP
BUSINESS NAME AND ADD RES
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2...'2. w6~, /91' S/ {{.I11E" 8 tV '1 tJ'1
(Number and Street) (City) (State)
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(Zip Code)
"2{L... Z. S' lOO,",
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:
V!\L.L E::)'-O GAt..)"'" N k f2-
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
R t)S'$ M eL.L l So~
HAst.~ CUtU'1l~
c;AN""NG~
II. SPECIFIC LOBBY ISSUE:
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c... -r'-8'JT C UCI\Ji'" 0 7- - 0 ~ ,
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r Professional Relationship
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Cf AR.. ~ ?'A t1-f'1 L
H AJ< S"k:
IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ')AGAf2- "1
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";
D Yes ~: Are YOU lobbyinq on a Dresent or Dendinq bid for qoods. eQUiDment or services. or on a
Dresent or Dendinq award for Qoods. eQuiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues";
DYes~: Are YOU lobbvinq on a Dendinq aDDlication for a DeveloDment Aqreement with the City or
aDDlication for chanqe of zoninq maD desiqnation or chanqe to the City's Future Land Use
MaD?
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 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 COMPENSATION DURING THE
REPORTING PERIOD,
~-
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:
VI,
VII.
SIGNATURE AND
of I entificati n
.... UI.IAM R. HATFIELD
~. ..f"...... Notary PublIc . stale 01
g.. · 'iMlc:an.,,wQjI~Feb18.2009
- ~lAMV11u1On II DO 375299
",:f,'C:t~$'"'' Bonded Iv NaIonaI Notary AIIn.
ta e 0 orida, County of Miami-Dade
Sworn and subscribed before me
This ~day of 0t'tl..u~' ,20 [) -:f
// - '/'~,,~
);"t~~,d...+.u{./{ ,~.
Signature of Public Notary -'St e of Flonda
Notarization of Principal's signature
PRINCIPAL IDENTIFICATION:
0"Produced ID (~$f r' rY 7 10 J "7 d-I '" G
Form
.........., lILIAM R. HATFIELD
:.,.....~y f,,\Notary PubIc. S1afe or FIorldo
Iy known (Pri t! '~Febla.DW
~ ,. COmmIIIIon II DO 375299
Wf IOndedIv NaIIonaI Nc*:Iry AIsn,
6Co(~\For
o Personally known (L
State of Florida, County of Mia
Sworn to and subscribed before me
This lid f?. day of hlll4-C.4 ,20!!.'1
'-~"./)-~ ~. !1"L;(
Signature of Public Nota - State of Florida
Notarization of Lobbyist's signature
FOR CLERK'S ~ ONLY ~h I 1,,-:]
Annual Registration fee: ] Yes [ ] No Amount pait2..~# ~ ~~Date Paid ~
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS,d&--' Revised 12/08/04