Scott Orth (no address) REcEWEO
1700 Convention Cen~er Drive, Miami Beach, FL 33139
Emalt: dtyderk&~d.mlaml~-aCh.fl.us 03
LOBBYIST REGTSTRAI'ION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-~[
n Check Box If an Amendment
T) DATE QUAL]~ED AS LD.~BBYI~T~
BUSINESS ADORE~S~: (.~,~l*lber .nd S~t)~ ~ (Oty) (State) (Zip Code)
.............
TELEPHONE NUMBER: FAX NUMBER:
X. LOBBYr. ST RETA3NED BY:
BUSINESS ADDRESS: (Number and St3'eet) (City)
(State) (Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
Fill out this section if pHndpal Is a Corporation, Partnership or Trust [Section 2.-482 (c)]
· NAME OF CHIEF OFRCER, pARTNER, OR BENEF[OARY:
· LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP II~I:AEST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
TT. SP~FZC LOBBY ZSSUE: ./"' ~ ~. ~
~ In detail):
ITT. CI'TY AGENCZES/ZNDIVZDUALS TO BE LOBB/ED:
A) Full Name of Zndlvidual/TIUe
B) Re~donship
D~SCLOSURE OF TERMS AND AMOUNTS OF LOBBYZS'r COMPENSA'r[ON (D~CLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
B) PR.tNC:[PAL'S DISCLOSURE (OF ~ COMPENSATION):.
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR~ EACH LOBBY[ST SHALL SUBMI'r TO THE ~; '( CLERK A SIGNED
STATEMENT UNDER OATH, LZ~I'IING LOBBY](NG EXPENDTI'URES TN THE CTI'Y OF MZAM! BEACH FOR
THE PRECEDZNG CALENDAR YEAR,
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions contained in S~ection 2-482 of the Niami Beach City Code as amended, and all
reporUng requlrements.
Signature of LobbYist:
Signature of Prindpal/Client:
LOBBY[ST ZDENT~F/CAT][ON:
Produced ID
Form of [dentification
s~GNATURE AND $'I'AHP OF NOTARY OR DEPUTY CLERK:
State of Rorida, County of Miami-Dade
Sworn to and subscribed before me
Th~s / ~/~ ,day of ~ · 2003.
Pe~monally Known
Si~rr~N~of Florida
~ ~._~l~tc..~ Liliam R Hatfietd
My Commissi°n DDO02020
Print, stamp or type~e~i~if'N~f~l
r-OR CLERK'S USE ONLY
~] .~.,=o DATE:
Reg[straUon fee paid: .[<~Yes [ ] No
DATA ENTRY DATE:. -'~)
!
2nd Revision 1/27/03
F:'\Ct~HATL\Lobby[sts~=gi~b -~Lion03.doc