Jose Sanchez/Angel Leonir~'~`~f ; t .~`''~ r ~v~~ 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. princpal who seeks tb eraourage the passage, defeat or modification d
any ordnance, resottfion, adbn or decrswn of arty ~nmissioner; any adan, deasron, recormrerxJation of the Ctty Manager or ary city board or
committee; or any action, decsion or recommendation of any city persomel during the time period ~ the entire decision-malang Process on such
acfi~, decision or recortxnendafion that foreseeaby will be heard w reviewed by the city corrrrrssion, or a aty board or commttee. The term
specificaly includes the principal as wen as ary empbyee engaged in bbbying activities. The term "Lobbyists" has spadllc exdusbrrs. Please
ratter to Ordinance 200-3/36.
NAME OF LOBBYIST: (Last) (~~ (M•I)
f'R~°XIS ~~1f~?y,,e~ 5S5 ~ ISth S"f ~~ ~~ /~I.oMli FL 3313?
BUSINESLSS//S~~~NAME AND ADDRESS (Number and Street) (City) G .Ayr (State) [`~ ~ ~/ (Z~-Jp/C,~o~dq/e~~)/Q~ ,/
TELEPHONE NUMBER: FAX NUMBER: EMAIL•
I. LOBBYIST RETAINED BY:
_~G~-- f~~ ~ti
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (ZP Cam)
TELEPHON NUMBER: FAX NUMBER: (Optbns~ EMAIL: (OptionaQ
3~~ ~ ~~,~~ y~~ ~ 3Q~ moo. y~ ~ ~
r section if principal is a Corporation, Partnership or Trust [Sectron 2.162 (cp
• 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:
u.SPECIFIC LOBBY ISSUE:
~~~ ~' ~7~05 Nv~
issue' t4~ba bl,bied l~scHbs""ir~deta~"_
Iii. CITY At3ENCIESANDMDUALS TO IBE 60BBIED: (Pur:utrnt to city, code section 2~82(g)
include a sta~entNtt of the extsrrt of any business, Artsrtcial, farni6al, prohssioratl or other relationsMp, fiivinp raise to an
apperrance of an NnixvPri•!Y. with any City personnel troupttR to be bbbisd; furtFter, pursuant !o City Code Section 2•
482(ax4) include a statement of any corrtractrral relationship {paid or unpaid) from 12 months preoading the
c:ommencemerrt of service of City personnel to be bbbied.)
A Full Name of Ltdhridusl Title B) An Financial, Farrrlial or Professional Relationship
•C•~M
' IV. DISCLOSURE OF TERMS AND AMOUNTS
' RATE OR 071fER):
A) LOBBYIST DISCLOSURE: (Required)
LOBBYIST COMPENSATION (DISCLOSE WHEI'HtBt HOURLY, FLAT
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Requires!).
The tdolbwtng inibrnwtbn must be artswerod:
1) Pursuant tb Miami Beach City Code Section 2485 Entitled °Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
~~~ent or nendina awrlyd for ooods eauiomertt a service?
2) Pursuant to Miami Beach City Code 2-490 EntiUsd "Prohibited Campaign Contributions By Lobbyists On
Real Estate Devebpment Issues":
^ Yes ~ No Are wa bbbyi
Y. /~wJ C L . wA ..la
3) Pursuant th Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"bbbyisT' a: sat forth in Section 2-481 above) who only appsare as a representative of a rwt for-profit
oorporotion or entity wittwut special compensation or reimbursement for the appearerxe, whether direct, or
indirect, ip sxpre~ support of sx opposition 1o any item, shall register wish ills clerk as required by this
section but, shall not be required to pay any registration fees.
a ~e, . 'r:o Are 1rOY ...~~.entina a not~lbr-orotlt cotroor~itton or entlN vNthcut sosciat comoensapoe~
reimbursemen.L .
i do solemnly swrear that sN of the
provisions conisirwsd in Sss~on ~-4
Signature of Lobbyist:
regoing facts are true and~orrect and that I have read or am familiar with the
of the Muni Beach~r-£ods and aN reporting requiramerrta.
Signature of PrinstipaUClient _,,;i,(., J ,
YL LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
^ Pereona0y known (Lobbyist)
VII. SIGNATURE AND 8TAMP OF NOTARY:
State of Florida, of Miami-Dade ~~0p5~
_. and re me OQUgJ~~p~,9~cA
.-' T •s f No.~~~ oo
nature tary - S
"sign re
PRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
tYJ Personapy Ivawn (PrMd
~~'r~0¢f, MARILYN URQUIOLA
~ ~. MY COMMISSION # DD575573
State of Florida, Ctwnty srf Mia .ore EXPIRES: July I8, 2010
Swom and aubscnbsd re (~07) sss-0i ~ Fi«~da No+ery s~~o..~,
This day of ,2008
~'Srgna saf '~ ry -State of Florida
NotarizatJon of princf~al's signature
TO BE COMPLETED BY CITY CLERICS STAFF ONLY
Annual Registration fee: es [ ' ] No Amount Paid i ~ ~~ CR ~7~~ ~}-?S Date Paid _,~~ G!)r'
Lobbyist Registration Form received and verified by: '~ E1hQ. ~
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc Rarieed ~~~~~
V. SKiNATURE UNDER OATH:
m
C'~ryr of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK OfFice CityClerk~miamibeochfl.gov
Tel: 305.673.7411 , Fmc: 305.673.7254
LOBBYIST NAME: ~oS~ ~- ~°~`'C ~Zi
I understand that no later than Ocbber 1st of each yr, 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.
l) 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.
y-B-D~
Signature: -Date:
F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc