Francisco J. Ruiz/PR Racing Miami, LLC_ i
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City of Miami Beach Office of the City Clerl~' ~- ~'~ ~:- ~ , ,.,
1700 Convention Center Drive, Miami Beach, FL 3313 ~`
LOBBYIST REGISTRATION FORM 2~Qt9 ~iGl~ ~ ~ ~~ t2; Q3
Lobbyist means all persons employed or retained, whether paid or not, by a pnncipal who seeks to en6p~irta t passage, defeat or modification of
any ordinance, resolution, action or decision of any commissioner, any action, decision, recommendation o~thYV10n~~r,pr , n ,pity board or
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-ma~Cin~~~aess 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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TELEPHONE NUMBER:
(Last)
3 umber and Street) I
(First)
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(M.I) 33f T6
(State) (Zip Code)
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E~VCAI L: L,L,~-»
FAX NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLI T
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BUSINESS NAME AND ADDRESS (Number and Street) (City) ~S^ta_te) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: / -
~2' ~~i ^/ck'
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE: ~-*
Issue to be lobbied (Describe in detail):
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Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4sz(g)
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
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RATE OR OTHER): - - -•-~-•-------..._...~..,.......",.~.,,,
A) LOBBYIST DISCLOSURE: (Required}
B) PRINCIPAL'S DISCLOSURE,(OF LOBBYIST COMPENSAT}ON):
(Required). ~1 . ,Y~. _ 1z ` ~ ~;
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
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present or pending award for goods equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
implication for chance of zoning map designation or change to the Citv~s Future Land Use
Maps
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.
reimbursement. .
ignatu~ of Lobbyis•~, v t~~
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: _ -~-=--h~--~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
I°J Produced ID '~ ~~-#- ~p j
~? (~C,`, `~ ~ ~ 0 ~ ~~-~~ Produced ID / t~L~ I
Form of Ident~ron''~+' Form of Iden
^ Personally known (Lobbyist) ~;~rry.' R ^ Personally known (Principal) o
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VII. SIGNATURE AND STAMP OF NS ~~ ~~
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State of Florida, County of Miami-Dade z 9~ s9~s State of Florida, Count of Miami-Dade
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Sworn to and subscrib before me ~ o r
Thi da of 2-90 ~ ~, Sworn and subscri d before me
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~, , Y , 2008 ~ ~ °o ~ This ~~day of , 2008
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Si ature of Public Notary -State of Florid m °' ignature of Publ' Notary -State of FIB
Notarization of Lobbyist's signature Notarization of Principal's signature
i
r0 i3E COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [' Yes [ ) No Amount Pa'd $ C o c~ MCR # ~
Lobbyist Registration Form received and verified by:
F:\CLER\HATL~Farm~ ,.: nbby .^ F=.r-u.-~. ,, ,,; c,;,...,;.nr•
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Revised 03/27/2008
V. SIGNATURE UNDER OATH:
City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fox: 305.673.7254
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LOBBYIST NAME: ;~ ,r~G..r/1 Gii c.~
CityClerk@miamibeachH.gov
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I understand that no later than October 1st of each year, 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.
1) 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.
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