James J. Tommaney/Community Center Associationm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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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 dty 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.
N/IME OF LOBBYIST: _ (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS (Nun
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TELEPHONE NUMBER:
I.
RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
FAX NUMBER:
BUSINESS NAME AND ADDRESS (Number and Street) (City)
TELEPHONE NUMBER: FAX NUMBE . (Option -T
L ~ v/,l L ~. /(~ /
(State) (Zip Code)
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EMAIL:
s` Ct'1-j~j tgyt~a
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f
(Zp Code)
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EMAIL: (Optional)
out this section if principal 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 ISSUE:
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
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Street) (City)
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II1/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
iIAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) °L-t` (,~{'y'1,.' ..L ~!1,_,,,.L~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):~fReauirPdl Pa'L-[~ /`~L. /LJ D/JOA _
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":
~~~ ..~ ~C~ vices or on a
resent or oendin4 award for goods eauioment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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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..
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.
-.
l' 9
Signature of Lobbyist
I do solemnly swear that all of the foregoing acts 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
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
' ~/_ I` r1~,NiR N
TL---- -~~----
PRINCIPAL IDENTIFICATION:
Produced ID (/. I~iu'I~ L-iC .f,G f ~~~ ~fSQi produced ID
Form of Identification ~ Gr~ .~i
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF
State of Florida, County of Miami-Dade
Swom//t~~o~~-~~a//rJd subscribed before me
This ~,Lday of ~~gLS.11 7nf
Notary -
Form of Identification
(Principal)
ei%'••., GRAZIELLA L. OFFEN
MY COMMISSION # DD 424537
~~, EXPIRES: July 10, 20^9
is; `'~~ Bonded Thm ote Pubfi-' -' &rwrit rs
unty of Miami-Dade
Sworn and subscribed before me
GfiA11Et ' L, of , 20_
MY COMMIS- ' ~~ ~? DD 424537
EXPIRES 'Q 2009
BondedThrtr>~.:~~ SI~O ubliC NOta
___ ry -State of Florida
'~'°""~"' of Principal's signature
FOR CLERK'S USE ONLY _
Annual Registration fee: [ ]Yes ('` ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISTfORM 05.doc ~ ~ ~.;~~~ ~;~Z~~; k -,~ ~,~t
Revised 12/08/04