Cathy Leff/The Wolfsonian FIUm 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" ha`s specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOrBBYIST:
t,.~ a \-b s o r~ ~ r.
BUSINESS NAME AND ADDRE
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t (Last) ' • , (First ~1 ~~ ~~iMn (~~
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S (Number and Street) (City) (State) (Zip Code)
3oS S 31- 2133 U~,~-~c. C,,~'i J . Q~\ ~~- 3313`1
TELEPHONE NUMBER: FAX NUMBER:
I. LOBBYIST R1~ETAIrrNED BY: 11
~e, Wo1tSOMcA1~ -.FC~~, a~
NAME OF PRINCIPAL/CLIENT:
EMAIL:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (S te) (Zp Code)
~oS - S3S -- Z.~ ~ S.
TELEPHONE NUMBER: FAX NUMBER: (Optional) 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:
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: ~ ~S,~tX ~ 1.0.n,V~t.~,l~.t~-~
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
.~~~~~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATE OR OTHERt
A) LOBBYIST DISCLOSURE: (Required) J~[, aC~ 2-~ ~i, ~ ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). S~`<<~~~-~
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 lobbvina on a present or pending bid for goods, eauipment or services. or on a
present or Dendina award for goods eauiDment 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 Dendina application for a Development Agreement with the City or
application for chanae of zoning map designation or chanae to the C~tv s Future Land Use
Man?
3) Pursuant to Miami Beach City Code 2-484 (h} Any person (except those exempt from the definition of
"IobbyisY' as set forth in Section 2-481 above) who only appears as a representative of snot-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 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 PRECED CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT E OR COMP NSATION DURING THE
REPORTING PERIOD. „ ~ ~ ~ /~
Signatu of ~ '
I do solemnly swear that all of the foregoing fa are true and co reef and that I have read or am
familiar with the provisions contained in Sectio 2- 82 of the Miami Beach City Code and all reporting
requirements. l ~~ /
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~__ Produced ID
Form of Identification
l~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
o r. Sworn to and subscribed before me
°o ~ This day o ~. 200
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Y p ~ 'nature of P li ry -State of Florid
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~x Notarization of yisYs Signatu
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3 • `~~~ Annual Registration fee: [ ]Yes ] No Am
>~g Lobbyist Registration Form received nd verified by:
~+o,~, ~ ~~" F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM C
P PAL IDENTIFICATION:
C Produced ID
Form of Identification
,Personally known (Principal)
State of Florida, County of Miami-Dade ~ ~
Sworn and subscribed before me LL o
This y of D ~. 2 ~~ ~ o 0
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Signat a of Public N ary - e of Florida 3 `6 ~,
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Notarization of Principal' ignature ~ ~ ~ .~
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ONLY /
MCR Date. Paid ` ~' ~a~
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Re iced 12/OS/C~4 ~s
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