Affidavit - Royal Palm Hotel
~
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Olive
Miami Beach, Fl 33139
cityderk((ilci.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 COMMlSSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMITTEE; OR ANY ACTION, DECISION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERlOD OF THE ENTIRE DECISION-MAKING
PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMITTEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVmES 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: tt4t5€Mf '''-Moedo :J
Last Name Rrst Name Middle Initial
Business Phone (301)
'f 'f ( - /Z. 7Z..
Business Name and Address:
JG-"'!t SW ~
No. Street
Email Address:
2) Principal Retained by: rZl} f t'to'1-9t III-v, Ih-..,.7..
tOo 5€ Z. S -, S",~~ l.(ft>f"O
If different from above Street Suite
h,4n/ h T3/'3J
City State Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
benefidary or interests.
[CJt.'s
Message Phone <-)
(J"~St;""" L. cc.
.
S"l
Suite
UJ'-(~
,., IAnl
aty
Ii...
State
3113,r
Zip Code
3) Subject Matter (Describe in Detail):
!to"",- '#'1-..,.., t/,,~""1.
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied:
CA,"'''IS$I"", ./- 4odl'>''''1 >.,,,,,,,?I<MI
5. 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
a City Commission Subcommittee on .2001
a City Staff on .2001
a Oty Board or Committee on .2001
a Personnel on .2001
a Identify Others on ,2001
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above:
;';/4
ON OCTOBER 1 sr 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 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 2-482 of the Miami Beach CIty Code as amended, and all reporting
requirements.
CD AfA - "). (] /
Signature of Lobbyist:
a ~lIy known
~~~~ 10
~ke an oath, or
a Did not take an oath
Identify
State of Rorida, County of Miami-Dade
sworn~ SUbscri~
This day of 001.
c~
r Deputy erk
If Notary, print, stamp or type as commissioned
Registration:
[ ] REJECTED
If rejected, state reason: ~
Registration fee paid: [ ] Yes [ ] [] Not-for-':bf~
[ ] Cash ,k MCR#
DATA ENTRY DATE: . 2001 ENTERED BY: