Kirk Paskal/Winter Music Conference~ MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
' ' 1 YIST.
~J~~~~ 1, `uJ~L
BUSINESS NAME AND ADDRESS
f 54-S-o3-~~E`~~
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, derision 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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
t~a~ko..l Ki ~ V(.
NAME OF LOBB ••
NUMBER:
I. LOBBYIST RETAINED BY:
W i n~er' I'Y1us i C, C,pr
NAME OF PRINCIPAUCLIENT~
~i n~P.r'' t~luSiC. L
BUSINESS NAME AND ADDRESS
~5'f-5(03-~~ ~{
TELEPHONE NUMBER:
(Number and Street)
~ 5~•-5(03 -~
FAX NUMBER:
e
(t-irst) (M.I)
NE. l a ierraCe. , ~.Lcw~c,~ 3333 f
(City) (State) (Zip Code)
99 KirlC_ h~~ ~ )ire-1~~~,'.~..~., n,...~,i~,~.
t~,ce , ~~so tiE
(Number and Street) (City)
q S~-Slo3 - c 59 9
FAX NUMBER: (Ootionall
EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Louis 'Foss en-ri
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Lou ~'~ Possen~i -~ l:t~i ~ t i a,m Kefty Jr.
II. SPECIFIC LOBBY ISSUE:
Issue to be lobbied~(Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
.l~c~ 333
(Zp Code)
. C 0Ir
v~ ~~-d
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required)
Sal
0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ ~1 ~~ ~ ~/L1 LZ-
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 ~NO: Are you lobbying on a present or pending 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":
^Ye~No: Are you lobbying on a uendina 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
Ma°?
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 J~NO: Are you representing anot-for-profit corporation or entity without special compensation
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 EXPENDITURES, AS WELL AS COMPENSATION
RECENED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YE STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO faC NDI'TURES OR COMPE TION URING THE
REPORTING PERIOD. ~~~ ~ _
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts true an correct and that I have read or am
familiar with the provisions ained in Section 2- 2 of the ami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
P
~~~ ti MARIAA FERNAND~ of Identification
~?'• MYC MMI8310N ~blA ~~n obbyist)
~Pli~~ n~w`~~
~.iiG~ BondW inru Nat~N PuoNo
E AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn a d subscribed bef a me
This ~~day of , 20 ~~--
r
Signature of u ota - Sta of Florida
Notarizatio Lobb ~5t's signa~re
Annual Registration fee: [~/f Yes [ j No Am
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MAR]:A-M\Lobbyist\LOBBYIST fORM 0
PRINCIPAL IDENTIFICATION:
P ced ID
Form of Identification
^ Personally known (Principal)
V~p~ MARIA A. FERNANDEZ
f'~ MY COMMI93{ON N DD 673984
State of Florida, County of Miami I EXR!RE®~J~ly1®'~i8
Sworn and subscribed be re me ,' ~ ~a~gfirruNarsryPuducUndr+rvnnero
Thi~~day of ~ 2
Signature of P to - ate of Florida
Notarization Princi al' signature
ILY
MCR # ~ ~~Date Paid 2-~ D
Revised 12/08/04