Leslie V. Pantin/Arteaméricas, Inc.~ 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 exclusions. Please refer to Ordinance 2004-3435.
l..~S 1 •
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) ~ (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
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: L~J
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: LQ~~1C v• P~~fi,~ ~~ramilioCallejc-
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II. SPECIFIC LOBBY ISSUE: ~~r t~,~n ~ ~~~e~t~i ~~n~~ grA~t tvow-
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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
Miami aeach vCA I Novi
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
PLAT RATE OR 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":
Y : Ar lob in n r n r n in bi f r d i m n r rvi r n
present or pending award for goods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes ~IVo: Are ou lobo in on a endin a lication for a Develo ment A reement with the Ci or
application for chance of zoning map designation or chance to the City's Future Land Use
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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 ~IVo: Are you representing snot-for-Drofit 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 COMPE N DU THE
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REPORTING PERIOD. ~~
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Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct hat I have read or am
familiar with the provisions contained in Section 2-482 of the mi ch Code and all reporting
requirements.
Signature of Lobbyist;
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to d subscrib d of re me Sworn a d subscrib b e me
Thls day of , 20G Thls day of 20~
,~~ pv No~ry Public State of Fonda ~,t/ S
Signatu a ~f I ~ N ~ F '~a Signature of Public Notary S e of Florida
Notari a o~ ~ N riz i n f Prin i t
ota at o o c pa signature
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~~ FOR CLE 'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid 4 ~ d
Lobbyist Registration Form received and verified by:
F:~CLER~$ALL~MARIA-M~Lobbyist~LOBBYIST fORM OS,doc Revised 12/08/04
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