Zack A. Ziffer - Annual Lobbyist Registration Form ANAI -
City of Miami Beach (V\
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
- City Clerk's Office
Tel 305-673-7411
Fax: 305-673-7254 `Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Jack A. Ziffer, PhD, M.D.
Business Name: BAPTIST HEALTH MEDICAL GROUP
Address: 6855 Red Road, Suite 600 Coral Gables, FL 33143
Office Telephone Number: 786-662-7655
Cellular Telephone Number:
Email Address: JZiffer @baptisthealth.net.
If more than one lobbyist,please list:
1)
2)
3)
4)
5').
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR WO 114 Li
Amount paid: cO 4-1 day-t-' Date paid: I q )1(
Processed by_ Ct Q—�W Date: ( ZI I r
FfLLERiSALL'aFORMS'L.ZBBYIST FORJAS4.4.NKUAL LOBBYIST REGISTRATION FORM mg:rim: