Affidavit (06/28/2001)
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Conventlan Cenlr:r Drive
MIlrnJ BelIch, FL 33139
citvcl@rk,ci.miami..b@arh fI U~
AFFIDAVIT
LOBBYIST MEANS ALl PERSONS E~OYED ~ RETAINED, WHETHER PAID OR NOT, BY A PRINCIPAl WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICA110N OF ANY ORDINANCE, RESOlUTION, ACTION ~
DECISION OF ANY COtofolISSIONER; ANY AClION, DECISION, RECOMMENDA110N OF ANY CITY BOARD OR
COMMITTEE; OR ANY ACTION, DECISION OR RECOMMENDA110N OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURING THE 11ME PERIOD OF THE ENTiRE DECISION-MAKING PROCESS ON SUCH ACTION,
DECISION OR REC0r+1ENDA110N THAT FORESEEABLY wn.L BE HEARD OR REVIEWED BY THE ,CITY COMMISSION,
OR A CITY BOARD OR. COMMITTEE. THE TERM SPi:CIFICAll Y INCLUDES THE PRINCIPAL AS WEll AS, ~Y AGENT,
ATTORNEY, OFFICER OR EMPlOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES
FALl WITHIN THE NORMAL SCOPE OF EMPlOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPlOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A 'CER11FICATE OF WITHDRI<WAl,"
1) , Lobbyist Ncme: CITRIN CharlesA.
. Last Name First Ncme Middle Initial
Business Phone QQ2) 674-0447
Business Address: 757 41st street
No.
Message Phone QQ2)
(Arthur Godfrey Road)
Street
FL
State
674-0447
Miami Beach
City
Email Address: chascitrin@aol.can
N/A
Suite
33140-3413
Zip Code
2) Prindpal Retained by:: FIRST AMERICAN 'l.'ELEX.U,1MUNICATIONS CORPORATICl\I
1527. NE .4th Avenue N/A
If different from above Street Suite
Fort Lauderdale FL 33304
City State Zip Code
(a) If a corporation, partnership, or trust, Identify end provide the address for the chief
officer, partner, benefidary or Interests.
3) Subject Matter (Describe In Detail): The enhancement of pay telephone sites,
includinq the introduction of adv@rtisina in cnn;lIDcri on wi th thp ~i h~~
J):....o.c:!.o.n....'y ]7=''I'"I'n;........rv;I rn FiT~t- Z!I.~r;r";:lin I'J\ola.t"V'lITRTl11n;,-,:::llt-i......nc ""r'\~. 1~?7 1\W
4th Avenue, Fort Lauderdale, FL 33304 (Goran DraQOslavic. President)
(PREVIOUSLY FILED Cl\I 1/31/01 FOR NATIClIIAL OUl'OOOR MEDIA NETWORK, INC.)
4. Identify each individual (Commissioners, BOCl'd, Committee, Authority member or City staff)
to be lobbied: All Ccmnissioners and Mayor and St",ff as neces""'rv
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
Xl The City Commission
Q City Commission Subcommittee
Xl City Staff (as necessary)
Q City Boerd or Committee
Q Personnel
Q Identify Others
.~2001
,2000
.2000
,2000
.2000
.2000
on ,Tll1y 1A
on
on
on
on
on
6. State the extent of lIlY business, finencia/, fcmilial, professional or other relationship which
exists with eny individual identified in number (4) above: My CClllPaIlY, Citrin Financial
& Insurance, Inc. has acted as insurance agent on insurance sold to the
MaYor.
'..Clc.''''
^ . 'i-"" ;'<;;:;"'}""'>> .'!- ,.
ON OCTOBER lSf OF EAat YEAR,. EACH LOBBYIST SJW,L SUBMJTTO ntECI'll' ",
CLERK A SIGNED STATEMENT UNDER OA11f, UmNG LOBBYING ElO'ErtDlTURES IN
11fE aTYOF MIAMI BEACH FOR 11fE PRECEDING CALENDAR YEAR. .
I do solemnly SN&r that all of the foregoing facts ere true and correct and that I have read or
am familiar with the provisions contained in Section 2-482 of the Micmi Beach City Code as
amended, and all reporti~#Uil"e}?en4th .
Signature of Lobbyist: ~ ~
1
i Persona/ly knovm
Q Produced 10
Identify
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 28th day of June , 2001.
C~ c
\9; Alt~A{DU""h
, IIft,"- Bx 1$s10N. ...<lIt,).
~""y ....;:::"8$''''0''9.:'116<''''
...... . .....
'QCo.
Q Did take en oath, or
Q Did not take en oath
Notary or DepUty Clerk
Cannen M. Dumas
If Notary, print, stamp or type as commissioned
FOR USEClNLY
Reglstratlcn: [] ACCEPTED [] REECTED DATE:
If rejected, sIatIl reason:
Reglstratlcn fee paid: [ ] Yes [ ] No [] Not.for-Proflt Or!lllnlultlon
[ ] Cash [ ] Check MCR #
DATA ENTRY DATE:
.2001
ENTERED BY:
.~<'\i
,
uw Omas
r \: \'1 'rS: CHARLES A. CITRIN. EsQUIRE
" I ", I'J,' \) '.) 757 "In' STorr (Amtua GoDPltIY RoAD)
{) II ^' MIAMI BIACH. FLollDA 331<l().3..13
\ ....r":
~. 'I' l:-
I v
"'::
TI1. (305) 67+{)++7
F.u, (305) 67.....8..3
email: chascitrin@aol.com
....fj
C"""w A, CrraIN \J \ ~\\
-
June 29,2001
City of Miami Beach
City Hall
Attn: Robert Parcher. City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
RE: CHARLES A. CITRIN
LOBBYffiTREGffiTRATION
Subject Matter: Pay Telephone Sites
Principal: First American Telecommunications Corporation
Dear Mr, Parcher:
Enclosed please find Affidavit dated June 28, 2001 containing my original signature which has been duly
notarized as well as my check payable to the City of Miami Beach in the sum of $25,00 for the registration fee,
Thank you,
Sinc Iy,
~A crrnrNl1di
CAC:cmd
CITYMiainiBeachLobbyist4