Christina Cuervo/The Related Group~ NI I ANI I B EAC H
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LO'BBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enmurage the passage, defeat
or modification of any ordinance, resolution, adion or decision of any rnmmissioner; any action, decision, recommendation of the
City Manager or any ciry 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 adion, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically indudes the principal as well as any employee engaged
in lobbying adivities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
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E OF PRINCIPAUCLIENT:
Jr(.~f - ~ ~, ~
~er and Street) (City)
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FAX NUMBER:
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(State) ~Zip Code~
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(M.I)
~~~~L-331~~
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if pnnc~pai is a Corporation, Partnership or Trust [Sedion
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECfLY OR INDIRECfLY, A 5% OR MORE OWNERSHIP INTERESf IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II• SPECIFIC L~ ~I ~E: ^ ~ ~
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issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individua~]TiHe B) Any financial, Familial or Professional Relationship
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
fLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) ~ ~ 1~ C- .
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)._ ~~~ U~
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 vou lobbvina on a oresent or nendina bid for aoods eauioment or services or on a
~resent or oendina award for aoods eauioment 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 vou lobbvina on a oendina anulication for a Develooment Aareement with the Citv or
aoolication for chanae of zonin4 mau desianation or chanae to the Citv's Future Land Use
Mav?
3) Pursuant to Miami Beach Ciry 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 a not-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..
^ Y~~lo: Are vou reoresentina a not-for-orofit corooration or entitv without soecial comuensation
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
RECENED, 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. ~ „ ~ .
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 Ciry Code and all reporting
requirements. /~ ~, . , ~ h
Signature of Lobbyist:
Signature of Principal/Client:
~.~-~-~.
VI. LOBBYIST IDENTIFICKTION: PRINCIPAL IDENTIFICATION:
^ Produced ID
~1 Produced ID
Form of Identification Form of Identification
ersonally known (Lo~byist) ~Personally known (Princip '""~~~:~^:r:~;: .,~,,,, ~..,,,~
. ~ ..~.. "'~,~,,,--~,
VII. SIGNATURE AND S~- 'rM1`ITA Y~~~'~' ,
~• ~`~Y"~. DELIL.A A. M~ ~
aY'``~ llELILA A ~ 5~ ~'n' CbMM1SSI0N p DD3~ 7R9
State of Florida, County of Miami- ti~vcoM ~Y~~ Florida, County of Mi i-D~~~ ~~:~
MISSION # DD3 °" eober 19, 2
Sworn to and subscrib befor ~t,~R~ ~~: ~3ZN n and subscrib befor~ie ~~X}, N,r„u~r °~
Octobet 19, 2 ~' ~0~"Q°0qj"rqswa Co.
day of ' ~Y Fl. Nowrvp~~~A~°~hi~ ,3 ay 2~~^'~'~~Mn,~
1 J l./ o .,.. °~~SIR~bVVvrb'^n//v4 ~ .,~~.kx.,'•w~;;~t, s u.... ~
.. ~ ~ ~ , .. -:~... . _ ~ e i O_ ~i ~~ . _- ~..., .
Si~Rature of Public No ary - 5 e of Florida ~~' ~"'" •Signat ru e of Public Notary - State or
Notarization of LobbyisYs signature Notarization of Principal's signature
FOR CLERK'S USE ONLY ''') /
Annual Registration fee: [~ ] Yes [ ] No Amount Paid MCR O` / Date Paid 1~~~
Lobbyist Registration Form received and verified by: .t ~`
F:\CLER\~ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~' Revised 12/OS/04