Leslie V. Pantin/Arteamericas, Inc.1 ;` ~ a ;.. ~ • ; ;
f
_~ - F
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 w retained, whether paid or not,
any ordinance, resolution, action or decision of any commissioner; any action ndeCision~recommendatceionr of the City Manager or an modification of
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-makin
action, decision or recommendation that foreseeably will t)e heard or reviewed by the city commission, or a y ~' board w
specifically includes the principal as well as any employee engaged in lobbying activities. The term °Lobb '~c~thyabsosard or committeeeS The term
rNer to Ordinance 20043435. y
pacific exclusions. Please
NAME OF LOBBYIST: rl aet\
AND ADDRESS (Number and Street) (Cit
9 ~ ~~L~. 3~ y~
N
C-
RETAINED BY:
.,JCLIENT:
AND ADDRESS rnl~~
(M.1)
~~ ~~ ~w~~~a ~,~,
EMAIL.
~ ~~~~
er and Street)
- - lv~owr (Zip Code)
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:
~~L~Q 4'• ~~i ~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OyfNERSHIP IN~'EREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST
~~' T f~.•-~-/v ~` mitt/'L., r,~( -~,,I
n.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail): a '" ~ "' ~~ V ~ ~• f
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4e2(g)
include a statement of the extent of any business, financial, familial, professional or other retationshi
#pp~arance of an impropriety, with any City personnel sought to be lobbied; further P. giving raise to an
4a2(a~4) include a statement of any contractual relationshi .Pursuant to City Code Section 2-
commencement of service of City peraonneFto be lobbied.) P (patd or unpaid) from 12 months preceding the
. _. "' t.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOt/RLY, FLAT
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 ooods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
a lication for chance of zoning map designation or chance to the City's Future Land Use
Maa?
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
s.~ect~ion but, shall not be required to pay any registration fees.
(~ Yes L~1'No Are you rearesenting a not for-prof+t corporation or entity without special_ compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION
t!'Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOT
State of Florida, County of Miami-Dade
Swom to an subscribed before me
This ~_day of _ i~, 2008
Signature of Public Notary - tale of Florida
Notarization of Lobbyist's signature
$ N ~ RINCIPAL IDENTIFICATION: ~ &
f3 ~,.°,oa
~~~ 9 0
~ ~ ~ ; Produced ID ~ ~ ~ S
~ g _ Form of Identification ~ ~
N
~ ~ Personally known (Principal) ~.
~~ ~
~ ,: ~ ~
U. $ U
2
late of Florida, County of Miami-Dade ~`"~""~•,
~,,I •1111,, a
. `Q~; ; worn and subscrib b ore me ~__
'4 ~ his day of 2008 ~ a;
:°s ~YOti ¢~M
f f
+•y~1' • i''~~ '1 /11111111``
11111, ignature of Public Notary - St of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S ~ MCR p Date Paid
Lobbyist Registration Form received and verified by:
DnvGcua n'~l'f i~snno
F:\CLER\HATL\Form_ ,lobby -' Nec _, -,r ~.;.,: F; ...,,.rtr~~
I do solemnly swear that all of the foregoing facts are true and~orrect and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami e~aelt-~itye and all reporting requirements.
~~,
a
r ~ "~
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, veww.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~ ~ ~~ ~~~ ~~~ IL~
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.
Signature:
Revised 02104!2008
.~.r !,I• ,f tE .: e~i. (3€ E.i-~si3.~~. ~ f pis, L .~;,f~t-.
l ~ ~~ a~
Date:
a
~~
4