David Sacks/Mathieu Rochette
to
.....
MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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.
NAME OF LOBBYIST:
Sacks
(Last)
David
(First)
E.
(M.!)
pathman Lewis, LLP 2 S. Biscayne Blvd.,
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(305) 379-2425
TELEPHONE NUMBER:
(305) 379-2420
FAX NUMBER:
#2400, Miami, FL 33131
(State) (Zip Code)
dsacksOpathmanlewis.com
EMAIL:
I. LOBBYIST RETAINED BY:
Mrlt:hiell Rochette
NAME OF PRINCIPAljCLlENT:
520 East Dilido Drive, Miami Beach, FL
BUSINESS NAME AND ADDRESS (Number and Street) (City)
33139
(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 SOlo OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
File No. 3294 - 520 East Dilido Drive
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
fua rei of AJ u~(d-
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHe;L~
FLA T RA TE OR OTHERf.
11> 4 d)" to
A) LOBBYIST DISCLOSURE: (Required)
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
o~ocurement Issues":
D Yes .~o: Are YOU lobbying on a Dresent or Dending bid for goods. eQuiDment or services. or on a
Dresent or Dending award for goods. eQuiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
~te Development Issues":
DYes ~o: Are YOU 10bbyinQ on a Dending aDDlication for a DeyeloDment Agreement with the City or
aDDlication for change of zoning maD designation or change 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
se . n but, shall not be required to pay any registration fees..
V. SIGNATURE UNDER OATH:
I do solemnly swear that all
familiar with the provisi
requirements.
Signature of Lobbyist:
Signature of Principal/Clien :
rrect and that I have read or am
i Beach City Code and all reporting
VI. LOBBYIST IDENTIFICATION:
1..! P duced ID
Form of Identification
, Personally known (Lobbyist)
f Miami-Dade
,e20 01
of Miami-Dade
,ef me 1)/
n ,2Y
VII. SIGNATURE AND STAMP OF NOTARY:
~ FOR CLE~~fS USE ONLY
Annual Registration fee: V] Yes [ ] No Amount Paid S li)i) MCR #
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA,M\Lobbyist\LOBBYIST fORM OS.doc
Date paid"!! ,j/iJ1
Revised 12/08/04