Barry S. Klein/Terry Bienstock~ ,~' 1
~ "5
~ i ~ 4 i
4. ~,„t~ ~.~~~ ~4_~. 1
.~
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 foreseeabfy 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 Ordfnanee 2004.3435.
NAME OF LOBBYIST: (Last) (First) (M.1)
Sao --~ ~s~ ~.. ~~so M tla~--~t 'P~~l~. ~l 35 ~ ~- (
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
30fJ - 8~- 2~~E-8 3 0~ '~'xv~ • ~'?.a ~~a~t»~~xt ~v~~' f~.r~ . a.a s~
TELEPHONE NUMBER: FAX NUMBER: t Fn~Fat~
1.
T~
NAME OF
LOBBYIST RETAINED BY:
~o,-s (Z -~,~-i {~v~ M (fir-t~'~~~- ~ 3~ ~ ~ ~
BUSINESS NAME AN ADDRESS (Number and Street) (City) (State) (Zip Code)
3d~ 5~2 -fib dr~-
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• 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: ,.~,5-~--ozt,G `~~c~~~ p~,-r,~-, '(~ ~-u~
Issue to be lobbied (Describe in detail):
ill. CITY AGENCIESlINDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-aez(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 Re ons ~=
.,j', ti ..
~~' .~ ,}
S ~ .~R~~-(J v-~- c~ .
„ ~
~ ~ ~ ~ Ir'1~ w t S ~a ~ 'f ~-,1
~ ~:
r.
'S
yY
a'
t
N
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required]
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
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":
/ '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":
application for chance of zoning map designation or change to the Citv's Future Land Use
Man?
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. .
V. SIGNATURE UNDER OATH:
nu ~nr~ n •-.~. . ST .... .- . ~.. . _.
of Lobbyist
I do solemnly swear that all of the foregoing facts are tkue~at~ correct and that I have read or am familiar with the
provisions contained in1Section ~-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyi§t
Signature of Principal/client: ~_~~~`"'-~ 4
Vl. LOBBYIST IDENTIFICATION:
educed ID ~ ~ Z--'~
~ ~ Form of Identification
o '~
ersonally known (Lobbyist)
,~4 . ~ IGNATURE AND STAMP OF NOTARY:
S
Florida, County of Miami-Dade
d subscribe bef r e
,g ~ ~ l~ day of pg
.c ~ /
lure of Public Notary ~iState of Florida
St~~ ' rization of Lobbyist's signature
TO BE COMPLETED BY CITY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $_`
Lobbyist Registration Form received and verified by:
F:\CLER\NATL\Form< .lobby,.' Fee,.;•,,.,;,,,: F•.; ~e.nr.
PRINCIPAL IDENTIFICATION:
Produced ID ~~~L ~ ~~JZ 3 ~ ~ ~ .~ j d 7-O
Form of Identification
^ Personally known (Principal)
- ~L G
S
°
'
tate of Florida, County of Miami-Dade 9,a~~
p ~
~
Sworn and subscribed before me
This ~ C~ day of SQ µhe~' ; 2008 ~
i~~'y
~ ~F `PS icy
~Si~nature of Public Notary - Stat of Flor
Notarization of Principal's signature ida G`'oj`~
~ $jo
~N
AC'S STAFF ONLY
_MCR # O__ _ Date Paid
Revised 03/27/2008
s
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fox: 305.673.7254
LOBBYIST NAME:
CityClerk@miami beachfl.gov
I understand that no later than October 1st of each veer, 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.
Si
{~ :~visacl 02; 04i 2008
3 ~
ate: