Affidavit (Quik Park)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerktCilci .miami-beach .f1. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRlNCIPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR DECISION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMmEE; OR ANY ACTION, DECISION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURlNG THE TIME PERlOD 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 COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRlNCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRlNCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTlVrnES 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 "CERTIFICATE OF WITHDRAWAl."
1) Lobbyist Name: [.(//<JJ f':/LvO~(\
Last Name First Name
,4.
Middle Initial
Business Phone (56')) V LI' . ) .,. ') 'l,. Message Phone ~ K>O 1 '(, "tr I
Business Name and Address: Lv/c. l.f f3,q Ls ~ (d.
"J(, i- 'J j'1..I FH.. J;-. 2-, Y I) /"rl J ~ I
No. Street Suite City
FL
State
J 'J/J :>-
Zip Code
Email Address:
2) Principal Retained by: QUI Ie.. PAIt Ie
If different from above
Y':I" 1.3 Y I tll..fl!
r City
Street
)(A)AA; PL
State
Suite
.., )) Jj
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
beneficiary or interests.
3)
Subject Matter (DeScribe in Detail):
'p AP.t:::) N C OPC~'f7 noN $
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied:
6'/1 01,....".... J.r J d.... c,,-../ ,-1 C"/"..,,, I J -I-y .J,.....
5, The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
B" The City Commission
~/ City Commission Subcommittee
t:l City Staff
o City Board or Committee
a Personnel
a Identify Others
.2001
,2001
,2001
,2001
,2001
,2001
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: JJn.J{.
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALENI?AR YEAR.
I do solemnly swear that all of t
with the provisions contained '
requirements.
Signature of Lobbyist:
foregoing facts are true and correct and that I have read or am familiar
ection 2.482 of the Miami Beach City Code as amended, and all reporting
a ~nally kn01 LIJ
ilJ""'produced 10 L
~d take an oath, or
a Did not take an oath
(.+20 - '7 ff! - 'I' \--- - ~:,- ()
Identify
State of Florida, County of Miami-Dade
Sworn tO~d SUbsWfore me
This ').{ day " 2001.
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~tJ"'"" Coc'
If Notary, print, stamp or type as commissioned
/'
Registration: [] ACCEPTED
FOR CLERK'S USE ONLY
[ ] REJECTED DATE: (j) I 7 ]) ) u J
'4' I I
If rejected, state reason:
Registration fee paid: Yes [ ] No...--f--'] Not-for-Profit Organization
[ ] Cash ['--ttheck MCR #
DATA ENTRY DATE: q 121 f 0 ( . 2001 ENTERED BY: ~