Michael Epstein/MESP, Inc.
~~i~~~
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST 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, 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 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.
~osfic~n ~1ir~te~ ~.
NAME OF LOBBYIST: r (Last) (First) (M.I)
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I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIE T:
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BUSINESS NAME AND A ESS (Number and Street) (City) (State) (Lp Code)
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TELEPHONE 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, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Nlichrn~~ E~sfiein
II. SPECIFIC LOBBY ISSUE: ~ rl 9 V' .- f~ ' ` ~-'~
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
l51'1U( AYV~ I IYI I/P.VY{'IIY/1 fiAt~gyl ~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATE OR OTHERt !
A) LOBBYIST DISCLOSURE: (Required)
~~.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
The following information must be answered:
i
1) Pursuant to Miami Beach City Cade Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes ~No: Are you lobbvina on a oresent or Dendina bid for goods, eauioment or services. or on a
oresent or Dendina 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":
oyes T~„NO: Are you lobbvina on a Dendina aoDlication for a Development Agreement witlt the City or
aoDlication for chance of zoning maD designation or chance to the Ciri's Future Land Use
Mao?
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..
^ Yes ENO: Are you representing anot-for-Draft corporation or entiri without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATN:
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 O MPENSATION DURING THE
REPORTING PERIOD. ~-
Si re 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~-bB2 of the Miami Beach City Code and all reporting
requirements. ~~j ~// ~ /
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
-!'~ProducedID ~f1V~C5 UC~aZS~
Form of Identification
i Personally known (Lobbyist)
VII. SIGNAT
aM~r ~ Notary Public State of Flodda
State of Florida, k~'~rrgiifr~t]ee la Cueata
Sworn to and sub i f reMMt~ommtasion DW03399
Thic 2fa .tom„ f ~ hSRPiNq.~IA/2011
Sgnature of Public Notary -State of'Floi
Notarization of Lobbyist's signature
PRINCIPAL
i._Produced ID
Farm of Identification
i Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn 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 /~ (~J ~/
Annual Registration fee: ]Yes [ ] No Amou eid ~_ MCR # "`-~~ JS J7 Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM O5. oc ~ Revised 12/08/04