Kent Harrison Robbins/David Wallack Real Estatem MIAMIBEACH
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 xclusions. Please refer to Ordinance 2004-3435.
~~ N .~ ~ ~ ~ t~Z~ ~~
NAME OF LOBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS tuber and Street) (ity) (fate) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL: C-O ~
I.
NAME OF PRINCIPAL/CLIENT:
DC~ Oc~l- n UJr. ~ ,/Vb~arn ~ .
BUSINESS NAME AND ADDRESS
(Number and Street) (City)
LLC
~~ 33/3
(State) (Zp
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME CHIEF OFFICER", PA~RT~ ER, 0 ENEFICIARY:
~a./I~ W ~ ~~aLk
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPQ~ATION, PARTNERSHIP Ofj TRUST; ,
II. SPECIFIC LOBBY ISSUE:
be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
~~ Or~e~s
Case ~tla. ~-I p~3 Z 8~s ~
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
HNB S~~ai Ma.,l~~ I Nance
~V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
c ,.,....,. ~
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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 [LiQo• Are you lobbvina on a present or pending bid for goods eauioment or services or on a
present or oendino award for goods, eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes 11i1~o• Are you lobbvina on a pending aonlication for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv'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 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 iTIVo: Are you representing anot-for-profit corporation or entity without special compensatilon
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPE ITURES, AS WELL COMPENSATION
RECENED, IN THE CITY OF MIAMI BEACH FOR THE P CEDIN LEND YEA A STATEMENT
REPORTING PERIODEN IF THERE HAVE BEEN NQr~P ITUR~~ CO EN ~ HIV DURING THE
I do solemnly swear that all of
familiar with the provision~nt
requirements. ~ /
Signature of Lobbyist:
Signature of Principal/Client: -ice
VI. LOBBYIST IDENTIFICATION:
Produced ID
Personally kna
VII. SIGNATURE
State of Florida, County
Sworn to and subscribe
~ Signature of Liibbyist
>regoin f are true correct and that I have read or am
in S~'i y>482 of ~~ Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
~i Produced ID LIE CORPORAN
Form of Identification ~~ , ~~ Q~UBLIC -STATE OF FLORIDA
V. Hall knovo_n ~l) COMt 11SSION # DD408442
P~BprtDac5,200i! y '~:ho-r~a~' EXPIRES 5/9/2009
~~~~~~~ '30NDEDTHRU 1-888-NOTARYt
#~ DD 37M6d
me
-~ ZOQ7
Signature of Public Nl~ary -State of Flor
Notarization of Lobbyists signature
~(of Florida, County of Miami-Dade
Sworn and subscr' ed fore me
This r' day of 20Q~• f
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK' USE ONLY
Annual Registration fee ]Yes [ ] No Amount Paid Oil MCR Date Paid
Lobbyist Registration Form received and verified by: _
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~ Revised 12/08/04