Affidavit - Royal Palm Hotel
CD
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention center Drive
Miami Beach, FL 33139
dtvclerkl6ld.miami-beach.f1.us
AFFIDAVIT
LOBBYIST MEANS All PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINCJPAL WHO SEEKS TO ENODURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR DECISION OF ANY ODMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMITTEE; OR ANY ACTION, DECJSION OR REODMMENDATlON
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 REODMMENDATlON THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMITTEE, THE TERM SPECIFICALLY INCLUDES THE PRlNCJPAL 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
LOBBYlST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: t... 1.IK.IS S "~I/€ S'7"'lI(
Last Name First Name Middle Initial
Business Phone ~ lt~1 -I ~ , 'Z.
Business Name and Address: L """'$
Message Phone L)
($""'SI<"-4 l.. t.C.
No.
3""1 $I.J
Street
t" .57
Suite
.
'2...:1'1 d
Oty
h 14",
Ii.. 3317.r
State
Zip Code
Email Address:
2)
Principal Retained by:
/00 S~
If different from above
h'4",
City
tLl1 /'
z.. .!7
1l.o'1'h.. "" /.1'> /1r,7f:t.
~~I1t;' ~r.S-o
Street
~
State
Suite
3 JI..J I
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):
.
/to..,4\. "fI,,., /h7/lL
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: /' _
'o,A/hh I ~ n (J N + ~"INI 5 ''''''' 71rt.N
S. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
a The Oty Commission on .2001
(] City Commission Subcommittee on .2001
Q Oty Staff on .2001
(] Oty Board or Committee on .2001
(] Personnel on .2001
(] Identify Others on .2001
6. State the extent of any business, finandal, familial, professional or other relationship which exists with any
individual identified in number (4) above:
NIl)-
ON OCTOBER 1 SF OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH
FOR THE 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 Sectio -48 of th Mia . Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
a ~nally known
tV'PrOdllced 10
Identify
a Did take an oath, or
a Did not take an oath
State of Rorida, County of Miami-Dade
Sworn 'y;)'j1f\d Subscri~
This · ['ffl day of 001.
~~'
or ~puty Clerk
If Notary, print, stamp or type as commissioned
Registration:
[ ] REJECTED
FOR CLERK'S USE ONLY
DATE: J '2:, -0 L_
If rejected, state reason: _
Registration fee paid: ~ ~ i;:sh[ ~] N~~~r~o~~~ 1
DATA ENTRY DATE: . 2001 ENTERED BY: