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Sonia Shreffler-Bogart~o~ w8 m MIAMIBEACH ~ ~5 ~OO~nnlxal ~ as-.o~ ,~~~ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means ali persons employed or retained, whether paid or not, by a P~P~ who seeks to encourage the passage, defeat or modiflption of any ord+nance, resolution, action or derision of any commissiorxr; arty action, derision, reoommendaUon of the City Manager or any aty board or committee; or any arifon, derision or recommendation of any dty personnel during the time period of the entire decision-making process on such action, derision or recommendation that foreseeably witl be heard or revle+nred by the dty commission, or a dty board or committee. The term specifically inriudes the prindpal as well as any employee engaged !n lobbying activities. Tha term "Lobbyists" has specific exdusions. Please refer to Ordinsnoe 2004-3435. S h re ~l~er - ~ ar-#- San is L. . NAME OF LOBBYIST: (First) (M I) EIPSt) A ~ ~ ra . BUSINESS NAME AND ADDRESS tNumber and Street) (City) (State} (Zip Code) 3o S ~ a ~ ~ w~,r TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: _ ~r~~l~ ~ ~ ~ c ~ off'' M I QiY11 i NAME OF PRINCIPAllCLIENT. ~l34 Co ~ ~I~bl r~15~-Glnt ~Jly~ ~1 ~ nzi ~~~t~~ ~1~8 BUSINESS NAME AND ADDRESS (Number a t) (City) (State) (Tp Code} TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if prindpal is a Corporation, Partnership or • 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 I~'c. Issue to be k~bb~ed (Desrnbe in detail). III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL I; FLAT RATE OR 071`lERj A) LOBBYISrDISCLOSURE:(Required) e V i B} PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).~~ ~1 The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign ConMbutions By Lobbyists On Procurement Issues": ' ~ D_reSent Or oendino eWard for goods gQ~.reuxerM rtr c- •~--'~ 2) Pursuant to Miami Beach Gty Code 2-430 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes ~o: Are vo lobbying on a ce:.din~ aocilcation for a Develocme Aareemerrt titi+itlt the r~r., ,.~ n aeaficatean for chance of zonir~ man deal^nation or chan..e to tthe City's Ft~*ure Land Use Mac? 3) Pursuant to Miami Beach Gty Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who onty appears as a representative of anot-for-profit corporation or entity without spedal compensation or reimbursement far 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.. 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 TIiERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signatu 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 Miaml~8each City Code and all reporting. requirements. C1~ ~ ~-y~ n n „ ., /, Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ~~'~,µ~,', RO RIO R. BERWIOES Fo of Identification °~•, No PubNe • State of Florida .4 ply liofa¢~h~t ist) ~. Commiasion ~ OD 713061 ,~j,;, a`'P - ~iifad AMP OF NOTARY: State of Fbrida, County f iami-Dade Sworn t~~ subsai me This (( d o 20Q.~ Signa re of Public Notary -State of Florida N rization of Lobbyist's signature PRINCIPAL IDENTIFICATION: c Produced ID Form of Identification _' Personally known (Principal) State of Florida, County of Miami-Dade Swam and subscribed before me This day of . 20 Signature of Public Notary -State of Florida Notarization of Principal's signature ' FOR CLERK'S USE ONLY Annual Registration fee: ]Yes ( ) No Amount Paid ~y©~ MCR ~ -c~~~Date Paid ~~ ~3 d Lobbyist Registration Form received and verified by: _~5 7 ~ c~ (/ F:`CLERK#ALL~MARIA-M~Lobbyist\L0661'IST fORM 05.doc Revised 12/08/04