Carmen Iuso/Christopher Innes
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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
Oty Manager or any dty 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 dty 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.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Stre) (City)
~o'O -cc;.'n - 8'2-00 q03- 6~6 -01.,0\1
TELEPHONE NUMBER: FAX NUMBER:
(M.!)
NJ' 07"11t;
(State) (Zip Code)
c..i\J~o @we.S "-e h.A. (..OM
EMAIL:
I. LOBBYIST RETAINED BY:
LhrI5{-ow""r r nne5
NAME OF PRINCI~~NT:
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BUSINESS NAME AND ADDRESS (Number and Street)
<108 - boB - (ill
TELEPHONE NUMBER:
SUMH'-\"
(City)
N:r
(State)
OlCjo/
(Zip Code)
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, DIRECfLY OR INDIRECfLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FL4 T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) Ho\Jrl~ 1/0. 0 {)
J
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
~OU/I\JtO.b{)
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes 3:No: Are you 10bbyinQ on a oresent or oendinQ bid for Qoods, eQuioment or services, or on a
oresent or oendinQ award for Qoods. eQuioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~No: Are YOU 10bbyinQ on a oendinQ aoolication for a Develooment AQreement with the City or
aoolication for chanQe of zoninQ mao desiQnation or chanQe to the City's Future Land Use
Mao?
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..
o Yes )(No: Are YOU reoresentinQ a not-for-orofit 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, 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 OMPENSATION 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. /7m" ,/'\~,
Signature of Lobbyist: ~~~
Signature of Principal/Client: ~
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
D Produced ID
Form of Identification
./ Personally known (Lobbyist)
Form of Identification
~ersonallY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade ~1. _I
S~orn to and SUbscr;ieea~J>~T~ ~(5io7
This :l>~or8j 0 .
. . MY I,;orTlITlISSlOIl r1 .5S1M
\.~,..I ExpIres October 02, 2007 ~7
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signat
State of Florida, County of Miami-Dade ,
swor/~ subscribed b fore me
This day of II/,) ~ J Permuy
~'7 . . My Commission 00255184
'\~r.J F~OdnMrO' '007 ~
Signature of Public Notary - State of Florida
Notarization of Principal's signature
I
Annual Registration fee: [ ] Yes [ ] No
Lobbyist Registration Form received and verified
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fOR
N~~R #~Date Paid
Revised 12/08/04