Ronald L. Book/USA Parking~ ,
~ MIAMI BEACH
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 encourage the passage, defeat
or modification of any ordinance, resolution, accion or decision of any commissioner; 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 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.
~ooK ~r~n~ I ~ ~
E OF LOBBYIST:
3~ '
2qqq N~ (°I I ~
(Number and Street) (City)
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FAX
I. LOBBYIST RETAINED BY:
V\~
~ e~
~333) Zo
Code)
i tLtPIiUNE 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, DIRECfLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Issue to be Iobbied~Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED;
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
,~I O
PRINCIPAL/CLIENT:
Aver~t~urdM.I g ~ ~~
~ ?531 ~
(State) (Zip Code)
) r I ba~Y~a . cn m
EMAIL:
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4
•
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf ~~ D
A) LOBBYIST DISCLOSURE: (Required) _ ~ b D b° a ~~--~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION)~ (Required)._~ I~ ODU ~~ ~, m
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":
~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
EsSate Development Issues":
cc.nc~~a ~~L~1 IIC 1
aa~lication for chanqe of zonina mao desianation or chanae to the Citv's Future land Use
Ma°?
3) Pursuant to Miami Beach Ciry 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 a not-for-profit
~ corporation or entity without special compensati0n 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
sedion 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 SU TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDI~IRES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRF~EDING LENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP~f~(DITURE 'OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all ore "~/
~g facts are true and correct and that I have read or am
familiar with the provisions containe in ection 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client: ~
VI• LOBBYIST IDENTIFICATION:
^ ProducedID
Form of Identification
~
~Personally known (Lobb~~~~~~~~~~~~~//
VII. SIGNATURE AND~\Awtb~ic~M~~b
~ -V~'~ h 13, 2p°A~• ~ '
State of Florida, Count~of~lia~e °s ~, :
Sworn~to~and subscrib~~f,6rE me ~.,n :*
of Public Notary
:ion of Lobbvis
PRINCIPAL
~ 7 Produced ID
Form of Identification
; Personally known (Principal)
State of Florida, ~ unty of Miami-Dade
Sworn a subs~{ i before me
This dayof ~ , 20d'
Signature,f~lf Public Notary - State;c~f Florida
Notarizaft~on of Principal's signature
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~P•'~JSSION' •;v ~~~
~ ~ ~~ch 13 2 ~'09 ; ~
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~ FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid f a MCR #Z~~Date Paid ~ Z Q~
Lobbyist Registration Form received and verified by:
F:\CLER\$A~L\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04