Elizabeth G. Freeman/E. Freeman
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 prindpal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or deasion 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 20043435.
Freeman Elizabeth G
NAME OF LOBBYIST: (Last) (First) (M.I)
Miami Dade College Fdnt/MIFF 300 NE 2 Ave Miami FL 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-237-7466 305-237-7344 egreenef~mdc.edu
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Same as Above
NAME OF PRINCIPAUCLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTE_ REST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
VCA Cultural Tourism Grant
Issue to be lobbied (Describe in detail):
nl. CITY AGENCIESH'NDIVIDUALS 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 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.)
or
VCA Grant Board
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required)
Non profit
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): NOri Profit
(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":
^ Yes Flo: Are you lobbyina on a present or pendina bid for goods, eauipment or services, or on a
present or pending award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes ~ No: Are you lobbying on a pendina application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Map?
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 snot-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.
~ Yes ^ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
.... ..,,~,....-.. , sr ..~ ~ ..., ..,,
Lobbyist
I do solemnly swear that all of the foregoing facts are true d correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the ly4is~mi Beach ty Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Pr du ID
Fyyg rm of Identification
°,~r NoWY Pubic - SfiM d Fbdda
~ ~~~ obbyist)
,a~"" ""~ TAMP OF NOTARY
State of Florida, County of Miami-Dade
Sworn to and subscribed a ore me
This ~ y of c ~ '~, 2008
ignat ublic Notary - f Florida
Notarization of Lobbyist's signature,
PRINCIPAL IDENTIFICATION:
IlJ Produced ID ~ aL
Form of Identification
^ Personally known
State of Florida, County -
Sworn and subscribed bef re me
This ~~day of ~ ~ , 2008
Signature of Public NotarylA State of Florida
Notarization of Principal's signature
TgBE COMPLETED BY CITY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S
Lobbyist Registration Form received and verified by:
F:yCt~ER1~t9P~YiS"rlLobbYist Registration Pnren 327Q8.doc"
VLY
Date Paid
/D ~ Revised 03/27/2008
~~t~
LILIAM R. HATFIELD
Notary PuWk - Sfafe of Fbrida
NtyC:orrrr~fonE~iesFsb 18,2009
Commission # DD 375299
nded By Naffonal Notary Assn.
m
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~ ~ ~.a.~,G-f-1~ ~ ~~`e ~~
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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Signatu e: Date:
,~ ~~~Yl~"r Lai egis~ratic~ Faun 327.clcic