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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, Fl 33139
cityclerk.@d.rniami-beach.f1.us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, \'\IHETHER PAID OR NOT, Ew A PRINCIPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, OEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOlUTION, ACI10N OR DECISION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMITTEE; OR ArN ACTION, DECISION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DECISION-MAKING
PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CfTY
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 ACTIVITIES 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 "CEJmFICATE OF WITHDRAWAL."
1) Lobbyist: Name: ~l~E.JU- ~\.4...~~ ~
Last Name First Name Middle Initial
Business Phone ~3 ~ \ -~ t \ L Message Phone ~ -
Business Name and Address: ~ \~ ~~ 4 J~('~
~ )l ~
';; \. ~~ \ ~\ tQ(D~ ~or\t.. ~\ ~ l ~L
Email Address: ~l~~-r~_-U."A-
2) Principal Retained by: ('\:l . L-'-~.
\s:;0(!) \c....~\ ~ ~
If different from Street
~\.~l~C\:=L }'\\.>~
ity State Zlp Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
benefICiary or interests.
.~-.. ~~"""...ll \.~GO \.1....'-.1...-~ *-<. ~\~\. ~ I t:.,- ~ ~l~C;
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Zip Code
Suite
3) Subject Matter (Describe In DetaO):
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,
,)
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4. Identify each Individual (Commissioners, Board, Committee, Authority member or CIty sIafI)
.~~~l.
"
5. The subject matter in number three (3) above is 1D be considered at the meeting d (Identify each entity or
individual):
CI The City Commission on .2001
CI City Commission SUbcommittee on . 2001
CI City Staff on . 2001
CI City Board or CommittEe on . 2001
CI Personnel on . 2001
CI Identify Others on . 2001
6. State the extent d any business, financial, familial, prttessional or oIt1er relationship which exists with any
individual identified in number (4) above: ~"--
ON OCTOBER 151' OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE arv a.ERKA SIGNED
STATEMENT UNDER OATH, LISnNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all d the foregoing facts are true and correct and that I have read or am famiUar
with the provisions contained in section 2-482 cI the Miami Beach City Code as amended, and all reporting
requirements.
Signature d Lobbyist:
CI Personally known
CI Produced 10
\\U~
Identify
CI Did take an oath, or
CI Did not take an oath
State d Aorida, COlJ1ty d Miami-Dade
Sworn 1D and subscribed before me
This Oay d . 2001.
~&
_ry c;: DttJul.y~
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: [~EPTED [] REJECTED DATE: .3 / r9 9/02-
If rejected, state reason: ./
~~:,~;;:i'f~ ]N~Prollt~
DATA ENTRY DATE: If 1 va-- . '"2OOl ENTERED BY:
II
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