Sellek, Mercedes 03/04/2002
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk(O)ci .miami-beach .ft.US
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACfION OR DECISION OF ANY COMMISSIONER; ANY
ACfION, DECISION, RECOMMENDATION OF ANY em BOARD OR COMMmEE; OR ANY ACfION, DEOSION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECfION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING
PROCESS ON SUCH ACfION, DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A em BOARD OR COMMmEE. THE TERM SPEOFICALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACfIVITIES 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: ~~k:.... Wf?Lce?eS
Last Name First Name
Business Phone (~ tf7ld- ~OO Message Phone (_)
/tIsc e') J te- /111 AJCeJt.
, ,
A~. ~ FI..1;dl
Suite City
If.
Middle Initial
2B~
No.
a III '-OA) JIJ
Street
Me2- erlffL
,
. ~~ FL -83)4~
( State Zip Code
Business Name and Address:
Email Address:
2) PrinCipal Retained by: t;;yJ:o/f-T 4f/:JCl.Jl-Pj ~l&tlJce~ ~4p /!~-I5J.iE
Jt4~ 7/$r
If different from above Street Suite
M /411/ IJ,aJc/1
City State Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
benefi~Wter~. f2/'2tTrfA
, !f7ZeCJIe/JJ
,
3)
Subject Matter (Describe in Detail):
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4. Identify each individual (Commissioners, Board, Committee, Authority member or City stam ~
to be lobbied: l:foNe ..
I
5. The subject matter in number three. (3) above is to be considered at the meeting of (Identify each entity or
individual):
{304f2h oF AbJV~
CJ The City Commission
CJ City Commission Subcommittee
CJ City Staff
~City Board or Committee @/JAt2D ~.p 'I)J1K:rH~
CJ Personnel
CJ Identify Others
on
on
on
on
on
on
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.2001
.2001
. 2001
.~2PtP2
. 2001
. 2001
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing fc;lcts are true and correct and that I have read or am familiar
with the provisions contained in Sectio -482 of the Mi mi Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
CJ ~onally kno
g../Produced ID
~~ake an oath, or
CJ Did not take an oath
a
State of Florida, County of Miami-Dade
S~orn i #subsc~fi;to~e ,g~
This day O!J~OOl.
~~
. -Netary 9r'6epUty Clerk
If Notary, print, stamp or type as commissioned
Registration:
~~ED
FOR CLERK'S USE ONLY f
[ ] REJECTED DATE: "..:6) '9f () y
If rejected, state reason:
Registration fee paid: Yes [ ] No [] Not-for-Profit Organiz .
-riLr:#- ] Check. MCR # !l
DATA ENTRY DATE: ~ Q r-~- ENTERED BY: