Affidavit
CITY OF MIAMI BEACH
OFFICE OF THB CITY CLERK
LOBBYIST RBGISTRATION
AFFIDAVIT
LOBBYIST SPECIFICALLY INCLUDES PRINCIPAL AS WELL AS ANY AGENT,
OFFICER OR EMPLOYEE OF A PRINCIPAL. EACH PERSON WHO WITHDRAWS
AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF
WITHDRAWAL,"
,
(1)
Lobbyist Name KATZ.
LAST NAME,
Business phone (~)573-4455
ERIC
FIRST NAME
S. (RTf:)
MI.
(2)
Business Address 4141M1'? AI1!~ , #ln1D, r.Jjamj, FL
Principal Retained By: Kimley-Horn
Zip 33137
Principal's Address
420 Lincoln Road. #353
(IF DIFFERENT FROM ABOVE)
M; em; Rperh I'LZip 33139
,
a. If a corporation. partnership. or trust, identify and provide the
address for the chief officer, partner, beneficiary. or interests.
Same as above.
(3) Subject Matter~~rtbe in detaf]~
rl ;pnt rllY'rent Qu.iJ'lesg llI~tt9SS V1ithiR the City sf rliaffli Beahl..
(4) Identify each individual (Commissioners, Board, Committee, Authority
member. or City staff) to be lobbied.
Members of the admini~tret;nn, rnmm;"io", city bg~rds.
(5)
The subject matter in number (3) above is to be considered at the
meeting of: (Identify each entity or individual)
o The City Commission
o City Commission Subcommittee
o City Staff
o City Board or Committee
o Personnel
o Identify Others
19_
, 19_
, 19_
19_
19
19
on
on
on
on
on
on
.
(6) State the extent of any business, financial. familial, professional or
other relationship which exists with any individual identified in number
(4) above.
NONE
ON JULY 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO mE CITY CLERK, A
SIGNED STATEMENT UNDER OAm. LISTING ALL LOBBYING EXPENDITURES IN THE
CITY OF MIAMI BEACH FOR mE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true and correct
and that I have read or am familiar with the provisions contained in
Section 2-48 of the Miami Beach City Code as amended, and all reporting
requirements.
~J-V
Signature of Lobbyist:
o Personally knoW!;!. ~
lt1'roduced ID D
k 3;;)()- ~ /7 ~iJc, - -5 </0- 0
(JDENTl FYI
o Did take an oath, or
o Did not taKe an oath
State of Florida, County of Dade
Sworn to a. nd sUbs~l1 bef~e "J.Ml(
this ~~day of ___.~L/
. .~~
G.J( 'cum ~.
If 8 Notary:
.~, Uliam/l Hatfield
\"J-.i My Commi..... 00002020
..'" Expires February 18, 2005
******************************************************************************
ACCEPTED
o R&JECTED
Registration:
DATE
If rejected, state reason:
Registration fee paid:
DYes
o No 0
o
o Check
Not For Profit Organization
Documentary Proof Att ched
MCR No.
o Cash
DATA ENTRY DATE
, --l5' dOO I ENTERED BY