Stuart Reed/Alexios & Carolina Camposm MIAMIBEACH
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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (L
BUSINESS NAME AND ADDRESS
(Number and Street)
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FAX NUMBER:
(city)
I. LOBBYIST RETAINED BY: ~
(Zip Code)
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EMAIL: jj
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NAME OF PRINCIPALJCLIENT:
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BUSINE AME AND ADDRESS ( umber and Street) (City) (State) (Tup Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST TN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFICLOBB .ISSUE: ;~ ~j"'~~
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Issue to be lobbied (Describe in detail): ~5.~- Z~ 2~~k~~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Tithe B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf.
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A) LOBBYIST DISCLOSURE: (Required) ~,n-r1,~ •' ~ ,-~ <~ ~ ~~' (''' c~U;-~
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Req' red). ~ t L; ~~.~ ~ ~~~ f
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 Dendina award for goods eauiDment or services ~~ ~~ Y~~
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~••~ •+ .ccn~Cni Wlin n
application for chance of zonino mao designation or chance to the City s Future Land U
Ma°~
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 PRE SING CAL DAR YEA A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEURES OR ,iIMPENSATN DURING THE
REPORTING PERIOD. ((
I do solemnly swear that all of the foregoing facts
familiar with the provisions contained j.~ction ~q
requirements. Cr ~ I I
Signature of Lobbyist
true and correct and that I have read or am
of the Miami Beach City Code and all reporting
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA ON:
L~Produced ID ~ ~ ~~L ~ ~P ~ ~~~ y G- ~.~U f h (~
Form of Identifies
^ Personally known (Lobbyist) w ~ o
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VII. SIGNATURE AND STAMP OF N ? ~1C
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State of Florida, County of Miami-Dade a ~ w ~
Sworn(~¢ and subscri~ed• before me ~, ~ ~
rni~~) tt-.___-daYoftt'~1-t1y~ ,20~~~ ~~W
Signature of Public Notary -State of Florida
Notarization of Lobbyists signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ .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 CLER 'S US ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid " MCR # ~~,~ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc
12/08/04