Ira Giller/Miami Beach Community Development Corp.
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MIAMIBEACH~ ~,'\ ~'~'~'j"~. ~~2~J'YD~R
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City of Miami Beach Office of the City Cle~~N 1 2 Zo07
1700 Convention Center Drive, Miami Beach, FL 331e~
Time
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the pa~ile, defeat
or modification of any ordinance, resolution, action or dedsion of any commissioner; any action, decision, recommendaliion of the
Oty 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 indudes 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)
LIlA
(First)
1):.
(M.!)
140
(Zip Code)
BUSINESS NAME AND ADDRESS
lID.
(Number and Street)
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I.
LOBBYIST RETAINED BY:
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NAME OF PRINCIPAljCUENT:
!t~ AltJIJ'" "VAJJ'~ ~ue.
BUSINESS NAME AND ADDRESS
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TELEP E NUMBER: .
M,M\\ ...c.tC
(Number and Street) (City)
1=L ·
(State)
a3t'''~
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~tJI'a" . MtTo.....
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ..,.,.. ,.... N."I"T
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
''It..1e. ~RVAT"N ...". W. tJ.
9QU' tip A'IlJ~1i\JT ~.#.,J~ -
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) _____ -. f
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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":
DYes
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes
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Are ou lobb in on a endin a lication for a Develo ment A ree . ent with the Ci or
aDDlication for chanae of zonina 'maD desianation or chanae to lh~ 'City's Future Land Use
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Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forthtin Section 2-481 above) who only appears as a representative of a not-for-proflt
.. 'corporatiol1 or eliitity. without special compensatiort or reimburseff1ent for the aPP1arance: whether ..dir~ct, 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..
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3)
.r. ,
ensation
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V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST qF EACH YEAR, EACH LOBBYIst: SHA~L SUBMIT TO..1HE~.<;ITY. CL;~R~ A SIGNED
STATEMENT UNDER OATH, USTING lOBBYING EXPE , AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE ECE CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP NDIT OR ENSATION,DURING TAE
REPORTING PERIOD. I
Signature of Lobbyist
I do solemnly'sWear tl1at all th
familiar with the provisions ontai
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. . LOBBYIST IDENTIFICAnON:
~t' :t ~ " ...
egoing~ facts are true and correct and that I have read or am
in 2-482 of the Miami Beach City Code and all reporting
D Produced ID
PRINCIPAL IDENTIFICATION:
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D Produced ID TL ~uei-!' L.I~~~
Form of Identification ~l.DlftO ...c;;41.(,~- 29/.0
Form of Identification
~ersonallY known (Lobbyist)
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
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.
FOR L
Annual Registration fee: [ ] Yes [ ] No Amount
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc