Steven Beko/Wade Patterson~ N1IAN11 BETH
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 recommendaton 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:
(Last)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL. V
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (
~! ~ S ~(~ ~ Z~ L} ~G~ ~ ~ I zU~ ` EMAIL. (Optional)
TELEPHONE NUMBER: FAX NUMBER: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHERr
~'
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
On Procurement Issues":
_^ Yes ~'6`No: Are you lobbying on a present or pendiing bid for goods equipment or services or on a
~ present or pending award for goods eauiument or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes [h.NO: Are you lobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Mau?
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 anot-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 ^ No: Are you representing anot-for-profit corporation or entity without special compensation
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 LENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU S OR COMPEN_ A; DURING THE
REPORTING PERIOD. ~
I do solemnly swear that all of the
familiar with the provisions contain
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
~r Nersonally known (Lobbyist)
Signature of Lobbyist
facts are true and correct and that I have read or am
'~ p 8 the Miami Beach City Code and all reporting
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn t,,o,a~d subscribe .' fo~ me
This % V day of ~"'T~~~ ~, ~p ~'
Signature of Public Notary -State f Florida ~ j
Notarization of Lobbyist's sig ature ~~~
Annual Registration fee: [ ]Yes No Am
Lobbyist Registration Form received d verified by:
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PRINCIPAL IDENTIFICATION: '~ ~- 'a
s
i~ g
Produced ID s4
Form of Identific n ~lOs
~sonally known (Principal) ~~ ~~~
..
ti~~~,
State of Florida, County of Miami-Dade ,~~
Sworn and subscribed ¢~f~r me '~qq
This ~_day of /` 20 ~~
Signature of Public Notary -State of Florida
Notarization Princ al's s'gnlature
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