Lee Brian Schrager/Southern Wine & Spirints of So. Florida AmendedY ~~ ~ ~ ~ tt ~
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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 princpal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or decision of any commissioner; any action, deasion, recommendation of the City Manager or any city board or
commiriee; 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 inGudes 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: (Last) 7y (First) (M.I)
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BU NESS NAME AND ADDRESS (Number and Street) (City) (Sta e) (Zip Code)
305.615 41"1 I ,c 1 ~ 4 O 3b5 - ~ 24 • 14 t)2 ~~SCttit.Ac(„~Q ~ S~ o.rrHra?,~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
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ut 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.SPEGIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-48z(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 ity Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid). from 12 onths 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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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optionaq
IY. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): - /
A) LOBBYIST DISCLOSURE: (Required) (~~j/
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): - ~j
(Required). JJJCCC///
The following information must be answered: ,
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
Qq~ rocurement Issues"
present or pendina 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":
^ Yes 'tid No• Are you lobbvina 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 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.
~f Yes ^ No• Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 15T OF EACH YEAR,
STATEMENT UNDER OATH. LISTING
IN THE CITY OF MIAMI BEACH FOR '
EVEN IF THERE HAVE BEEN NO EXPI
I do solemnly swear that II the o
provisions contained in S on 2-482 of
Signature of Princi
Ly'Personally known (Lobbyist)
facts are true ~d 3orrect and that I have read or am familiar with the
liami Beach Cit Code and all reporting requirements.
ersonally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of 12008
:ary -State of Florida
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Signature of Lobbyist: IA~-I~ ~
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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: ~~~ .DQI~
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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.
l~ ~ ~
Signatur Date:
FaCLERi!_OBY45T~C.obbyist Registration f=arm 32TD8,doc