Marguerite Possenti/Winter Music Conferencem 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, deasion 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.
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NAME OF LOBBYIST:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
Lt~~n~~ musiL
NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
ember and Street)
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FAX NUMBER:
_3450 utr (~, T'e
(City) (State)
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(M.I)
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(Zip Code)
wi n ~~r- muSt C.Con~er~nCt
Cam
(Number and Street) (City)
gs~+-se3-tsg 9
FAX NUMBER: (Optional)
(State) (Zp Code)
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:
~..C7ul'S 1'a5sen-h
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Loins Possen-~-t' - Wi t ll' Kell V 1-.
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (D scribe in detail):
III. CITY AGENCIES/INDMDUALS 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,
FLAT RATE OR OTHER
A) LOBBYIST DISCLOSURE: (Required) ~.lar,=2c~ P•m(~~4t{•te.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~~ V `~~ ~CT1L7~ Ut~'e~
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 ~'~Vo• Are you lobbvina on a present or pending bid for aoods eauiument or services or on a
present or uendina award for aoods, equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes~,~No• Are you lobbvina on a uendina application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City's Future Land Use
Map?
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 snot-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
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 COMPENSATION DURING THE
REPORTING PERIOD. w
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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.
Signature of Lobbyist:
Signature of Principal/
VI. LOBBYIST IDENTIFICATION:
~ ~A Produced ID ~ (-v lt,l/J /~ ~yt,(Uf~„f
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Form of Identification
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~ $ ~ ^ Personally known (Lobbyist)
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SIGNATURE AND STAMP OF NOT
~ ~
s .
ARY:
State of Florida, County of Miami-Dade
$ ~ Sworn to and subscribed before me
This ~
day of v C Q -~.
20 ~? Z
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+~ Sign of Public Notary -State of Florida
~ Notarization of Lnhhvist'c cinnatnra
PRINCIPAL IDENTIFICATION:
Produced ID ~'" t-v.~LI,Q/~ ,A,2 j U (;1~f
Form of IdentificationCl~~~ ~-~
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This ~_day ofo~ H~..., 20 i7
Signature of Pul 4~'C~Ibtary -State of Florida
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OR CL R 'S tISRONLY
Annual Registration fee: es [ ) No d ~V MCR # ~ ~ Date Paid ~~ a
Lobbyist Registration Form received and verified b
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fOR 05.d Revised 12/08/04
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