Hiram A. Ruiz/Rob Schuler - Condo Reform~~1
City of Miami Beach OfFce 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 wmmissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, deasion or recommendation of any city personnel during the time period
of the entire deasion-making process on such action, deasion or recommendation that foreseeably will be heard or reviewed by the
city commission, or a aty board or committee. The term speafically includes the principal as well as any employee engaged in
lobbying activities. The team "Lobbyists" has specific exclusions. Plesse refer to Ordinance 20043435.
LOBBYIST: (Last) (First) (M.I)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (Cfty) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n. SPl~~i~1C LOBf3'~ #$S~IE; ~ r~ ® ~ f ~ #~,.-. R ~~ .~^ v~ fie ~ ~-E< ~5 w
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Issue to be lobbied (Describe in detail): O _ / ~J
ul. CiTY AGENC~£S/INLi1VIDUAL~ TD;Bf L~~~Ep:
A) Full Name of IndividuaUTiUe 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
A) LOBBYIST DISCLOSURE: (Required) ~ ` ~ _
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). N `
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 [iyNo• Are you lobbvina on a Dresent or Dendina bid for goods eauioment or services or on a
vresent or vending award for goods, eauivment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
CYes C~IVO• Are you lobbvina on a Dendina aDDlication for a Develovme~rt Agreement with the Citv or
aaDlication for change of zoning may designation or change to the Citv's Future Land Use
~~
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 thy,appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the derk as required by this
sedion but, shall not be required to pay any registration fees..
No: Are "n -for- rata r 1 w n ion
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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE NAVE 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 City Code and all reporting
requirements. ~
Signature of Lobbyist:
~ ~-~-,/~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~~ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swor ~d subscribej~~befor me
This ~~,_=day of /'t~ , 20Q~y
$ieJn~Gre of Public Notary -State of Florida
Notarization of Lobbyists signature
FOR CLERK'S USE ONLY Q / N ~
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ MCR # /V ate aid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
PRINCIPAL IDENTIFICATION:
i Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Swom subscribed befo a me
This av of ~// Ln ~~ ~ . 7n~)
Signature of public Notary -State of Flor
Notarization of Principal's signature
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