Rene D. Gueits/Salsa Enterprises
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MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Ns~b;ISTl;
BUSINESS NAME AND ADDR
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 ecific exclusions. Please refer to Ordinance 2004-3435.
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(Last) (First)
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(Number and Street) (City)
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FAX NUMBER:
LOBBYIST REGISTRATION FORM
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(M.!)
,FL 33liD
(State) (Zip Code)
2G-Str~k8&P Jikv.(}o//1
EMAIL:
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LOBBYIST RETAINED BY:
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TELEPHONE NUMBER:
(City)
305 ;blo hCD7
FAX NUMBER: (Optional)
FL
53/65
(State) (Zip Code)
kG S1-~La'19t$ @) h;;fX;. CUt'h
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 S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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lobbied (Describe in detail):
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III.
ITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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B) Any Fina cial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) 0'
B) PRINCIPAL'S DISCLOSURE (OF LOBBY'; COMPENSATION)' (R'O"h...). ez/
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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":
~s 0 No:
ment or services or on a
2)
Pursuant to Miami B~ach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~;
oYes
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..
Yes 0 No:
V. SIGNATURE UNDER OATH:
K A SIGNED
ENSATION
ATEMENT
RING THE
I do solemnly swea
familiar with the provisio
requirements.
Signature of Lobbyist: \
Signature of Princip
VI. LOBBYIST IDENTIFICATION:
(prOduced 10 0", bG
Form of Identification
L IDENTIFICATION:
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Form of Identification
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o Personally known (Lobbyist)
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Personally known (Principal)
VII. SIGNATURE AND STAMP OF NO
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Annual Registration fee: [ ] Yes [,I ] No Amo
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARlA-M\Lobbyist\LOBBYIST fORM OS.doc
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This ~day of 6YItU) f'/\ ' 2012-=t-
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Signature of Public Notary - State of Florid
Notarization of Principal's signature
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This .:~ b day of YYjtLv t1 , 20fl~
.'i1~'Y71 2jejaJ:t.uL( .
Signature of Public Notary - tate of FlOrida
Notarization of Lobbyist's signature
Date Paid .51,-) 0/;.tiC-
Revised 12{08{04