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David Custin/Central Parking System of FlaCity of Miami Beach Office of the City Gierk .1700 Convention Center Drive, Miami Beach, `FL 3319 ,'' LOBBYIST 12EGISTRATiON >FORM .~ . Lobbyist. means all persons employed. or retained, whether. paid ;or not, by a principal ,who seeks to ,eoooulage .ttie passage,, defeat or modifieation.of any ordiHance; resolution, atEiori.or decision. of any ~i7ommissioner; any action, dedston;:recommendatlon of the' Gty {Nanage~ or any city board-or committee; .or'any-adlon, deasfon'or. ietommeiZdation~ of any dty.,parsonne! durirlg.;the Lima period.of the entire decision-making process orrsuch action, derision or. recommendation that.foreseeabty will be heard or reviewed .: ' by the°dty commission, or. a. dty board~6r~committee...The term specificaNjr.irYCludeS the principal as well"i+'s'any employee engaged ~ - . rnlobbying activities. The farm "Lobbyists" has speNfit.exctusions. Ple#sei'eferto Ordiinartc6 X0043435. ' _ EMAIL: (Optional} Fill oast this section if principal is a Corporation, Partnership or must [Section 2-492 (c)] • ;NAME OF. CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ ~ M ~ ~ r ~~ /~- IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MOR£ OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: /A ~O II. SPECIFIC LOBBY ISSU ~'F(' ~ l l -~~ ~e~ - ~arKi ~v~~ Issue to.be lobbied (flescribe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of individual/Title ej Any Financial, Familial or Professional Relationship ,M ~( C'pmml 55~~ o~I.S al I iC CC~r15.V.SZ -f-O Sorn.n_ ccrrvw.~~s`Ior~rS 'in 2©0 C~~ Nl r . -~ ~ le~r,-F- 5-IzzF~ 1~0 , , I ~Gtnc.is ~'G~'K'i ~~~ No , ,lll~ ~ eooz , 3 ?~ IVl. ®ISCE®~1~E ®fF ~E(idPR~ ~.F98'8 eRRAOUR145 ~~ !'.®C3BVY~ C®PA~6~At~'YI®R1(Dl~fl.o~ N4fPilEY0~0~~ Od~~B~~ f; ~~'dttkl Pe= ®R Q71~iF'Rf . ~} LOBBYIST DISCLOSURE: (H~equieed) _ ~ I ~~°' -" +-~-' ~~ n~ B)~PRINCiPAL'S DISCLOSURE (OF L068YIST COMPENSATION): (6tequiredi). w lfiae ffoil®wainc~ ingorrrtation must ~e arosvaererl: 1) Pursuant to Miami Beach City Code Section 2-4~i>i Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": present or ®ee~~irtap, ~wara- ><or ®ooai!a. eaui~mera4 ~ sert+ice7 ~~ 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 2-48I 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 c}erk as required by this section but, shall not be required to pay any registration fees.. Q9. SIiaAlA7illittE IDPdDER oA11'lil: ®Ri ®i~®~~~ 1~ ®F fEACo-i ~ffF~R, ~ACG4 L®>$~1(YSV StIA4.L S16~A9~ ~'®, 'iriFB~ CBYIf CLER6t !~ SIi~sP9E® ~S/4Y~A~~lmT 4BAiD1E6Y O~iYD•@, 1LBS'PIPiEs d®B~VIPiCv ~3YPEiN®YTURIES, ~ dM~LL ~S ~'oPR1PEY~iSi6TY®PB ~iEC~%!l~D, Y~ YO•il>: CY'YV ®~ 5vi1IANBY ~EA~~4 iF E PR ®EW6"a irA~~lPoDAit ~EA08. l~ SYAYrEO~Q~P4~ g@4AfLL ~~ iF%L!E® ~lEf4 g~ 'FaiIER~ >fi~@I(E i3EtE WI®~ I~AI ®Ot~c~l~$EI~1~Y%®t~ ®B~II~W~ 'iC'~!~ li@~~~"EIII~I~ PE6~Y®®. f I ~ -~~ Signature of Lobbyist I do solemnly swear t a f the foregoing familiar vuith the .pro isions co i din Ctic requirements. _ Signature of Lobbyist: C C true and correct and that I have read or am F tine Miami Beach City Code and ail reporting Signature of Principal/Client: @!I. 0.®~~1fISP IDEi11YIFIC.~'TB®iN: ~DL- ~Produced IDC235-1-1(0-(~ "'-~02-0 Form of Identification O Personally known {Lo4risyest) ~I. 3YGI166t,'FI1RE ~R1® F RI®M. U M ~ _~;,, ;,,: MY COMNii1S510N # f)D 676927 State of Florida, County of Mi ' e EXPIRES:,Nrne21,20t1 Sworn to,~nd subscribed bef ~ •~ ' n"""0~"~`~ This t__~.]__~n day of ~ • n, 20~ Sic~nai:ure of Public Notary -State of Florida fit®tari8aation og 8.obtayise's siga9afure ~iRYPoCI~AL IDgP9YIFY~i7'IOW: t] Produced ID Form of Identification personally known (~rincipsal AR[F?lE M. lAM .., MY COMANSSION # f9D 676927 EXPIRES: June 21,2011 5 e of Florida, County of Mia &ididn"""°r°'yP"°a`u~'a.'"'r""` rn ~ subscri efore me This i~ • '1 day of , 200 ~/)~ (~ ~.~~1'~ Signature of Public Notary -State of Florida Riotariaastbon off Prinei~i's signature • F®f~ CLE~tI~`~ a9 ~ ®I~L~ ~~OZ~d'~ ~ /l 0~ Annual Registration fee; [ ]Yes [ ] No Amount Paid ~ MCR # Date Paid Lobbyist Registration Form received and verified by: f:\CLER\$A~L\MARIA-M~Lobbyist~LOBBYIS7 fORM OS.doc ;~ l t ~ ~ Revised 12/08/04 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real . ~ ~ ~ ~w. , City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME~0.~~~'' ~~ r ( / I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. ~- ©2~pll2~og Signature: Date: Revised 02lOAf2008