Kirk Paskal/Winter Music Conference, Inc.m MIAMBEACH
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 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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NAME OF LOBBYIST: (Last) (First) (M.I)
l~in~e+! Y71u5ic- C:on~en~e. 3~F50 NE Ia.Terrare. F~•l.aud 3333y
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) .(Zip Code)
(qs~+~ 5103-'-~4~`f ~g5~)5~3-lSgq ~irlG f~win~ermu5l~ConF'erei~ce.Corn
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
lJl~ i n~~ Y~uS i L C on F'e,~'en ce , ~C.
NAME OF PRINCIPAL/CLIENT:
lei n ~ CYluS i c. Con ~er-e,~ce 345o WE I 1 Terrace F~ , ~~ X33 ~f
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (.Tip Code)
(RS~~ 5(03- ~~`~`~ (R5~~5~3-/5~9
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 OpFFICER, PARTNER, OR BENEFICIARY:
L.DU 15 f O.`,S~(1-t~1
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Lnci i s Po~~en-~-i - 1.~.) i t ~ l'QXYI Ke l l U J r
II. SPECIFIC LOBBY ISSUE:
y C P- - 'Tour ism t~d~ar~cemen ~- Co ran'
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional Relationship
Vc~ B
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf ~1I
A) LOBBYIST DISCLOSURE: (Required) ~~t~ P~i'Ylp~~l~Ze
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (RequireTd).~~i 2~ t/mp~c~ye2
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,~No: Are you lobbvina on a present or pending bid for goods, equipment or services, or on a
present or Dendina award for goods, eauiDment 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 lobbvina on a vending application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use
Mau?
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..
^ Yes ~H No: Are you representing snot-for-profit coraoration or entity without special comuensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS PENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR Y A ATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND URI° R COMPENSATION D~,IRING THE
REPORTING PERIOD. .--~ ~ /
' "Signature of Lobbyift
I do solemnly swear that all of ore Ding fa are ue and correct and that I have read or am
familiar with the provisions co 'S`e tion -482 the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID ~ ~
Form of Identific~tim.
Form of Identification
Personally known (Lobbyist) ` :- Personally kno n~Princi al) BHEILAALLEN
VII. SIGNATURE AND STAMP OF N A f ~ NoteryPublic,StataotFia~t
commlelilonN DDnotesa
~ My ilOihfll. eXplres Jwre a, 202
State of Flori a, County of Miami-Dade g cs ~ State of Florida,
Sworn to and ribed before me ~ ~ ~ ~ Swor subscri d kefpre me
3 ~.. -o ~ 1;;..~~--
This ~_d of - 20~ m N ?_, ~ This ~ay of ~ ,, 20 p~
~. O n -C
~~`~c
p ~i a~i 9
ignature of Publi otary -State of Florida ~ ~ ~i Signature of Public Notary -State of Florida
Notarizatio Lobbyist's signature m ~, o Notarization of Principal's signature
o :n
F SE ONLY Cy / ~o
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ MCR # ~ ( ~ 7( Date Paid ~~ ~- va
Lobbyist Registration Form received and verified by: ~ ~~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ~~%re~-~.) Revised 12/08/04
Miscellaneous Cash Receipt - - _ - - = ~ - -
ci~r of Mu-Mi B~-cw No 2 9 6 b 71
^ Cash ^ Credit Card Check # ~l ~ ! $ ~~ ~
Received of ~ " j ~- ;~'~- 1 "/ ~ ~ G ,~~~ ~ 1 G ~
Address
For
{THIS INFORMATION MUST BE COMPLETED) / t Finance Director
By
Account Number: v !~ ~ ~ ~ //
Preparer. ~'` ~' .Dept: ~ C ~~