Michael Hyman/Roney Palace Condo Association, Inc.~, ~ ! V s '}. .FdL k r.d ~1 888 ~ 1
a City of NFiami 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.
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NAME OF LOBBYIST: ~ (Lash ~ ~~ (First) ~ (M.1) ~~
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TELEPHONE NUMBER: NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRI IP UCLIENT:
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B~1lVE5T„~MDADDRESS.QC.~.(Number and Street) (City) ( (State) (Zip Code)
NUMBER: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)j
• 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 LQBBY ISSUE:
Issue to be lobbied (Describe in detail): ,,~~
nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:`'(P~,~~t~~ct code 2-as2
ty ~ lg)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required}
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~~ 1/~ Y~
(Required). V F r
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On P,~ocurement Issues":
present or pending award for goods eauipment or serYice~ -
2) Pursuant to Miami Beach City Code 2-490 Entityed "Prohibited 'Campaign Contributions By Lobbyists On
Re state Development Issues":
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3)
V.
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Maa?
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 repre$entative of anot-for-profit
cor~oraf nor entity without special compensation or reimbursement for the appearance, whether direct, or
indire ; to~ express support of or opposttion'to any 'item, shall 'register with the clerk as recuired by" this
sect' n but, shall not be required to pay any registration fees.
(es No: Are you representing anot-for-profit corporation or entity without special comgertsation or
reimbursement. -
SIGNATURE UNDER OATH:
I do solemnly swe all of th
provisions contain din Sec 2-
Signature of Lobbyist: ,
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICA'
' Produced ID IG~Z~~I~L<
^ Personally known (Cobb
VII. SIGNATURE AND STAI
State of Florida, County of Miami-
Sworn to and subscrib be re n
This ~d~r,of t>~.
Signature of Lobbyist
and correct and that I h.
ty Code and all reporting
reaq or am familiar with the
~irements.:
PRINCIPAL IDENTIFICATION:
^ Personally known (Principal)
State of Florida, County of Miami-
Sworn a subscribe~t be,~ore me
This .a~av cif L. JLcc~ ~r
'~~ Si( natu~E
;,~ Notari ~
Ann~grstration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\HATL\Form~ y;obby -t ~'"9+s~.- ~;~:.; F~..-K,.r,r,: Revised 03/27/2008
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY