Nelson Fox
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk(Ci)ci .miami-beach. fl. 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, ACTION OR DEOSION OF ANY COMMISSIONER; ANY
ACTION, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR COMMmEE; OR ANY ACTION, DEOSION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING
PROCESS ON SUCH ACTION, DEOSION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE cm
COMMISSION, OR A cm BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, 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 "CERTIFICATE OF WITHDRAWAL."
Lobbyist Name: q::::o r- N -eJA6 W
Last Name First Name
Business Phone (~~ 8I2..."' c::, l 0 (] Message Phone (3i()
Business Name and Address: /2-2. &f L c.. L ,
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City (
1)
Middle Initial
18rCfC()(
Suite
PC-,
State
Zip Code
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No. Street
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Email Address:
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2)
Principal Retained by:
If different from above
Street
Suite
City
State
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):
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4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: (~~ V ~
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5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual) :
0 The City Commission on .2001
0 City Commission Subcommittee on ,2001
0 City Staff on ,2001
0 City Board or Committee on , 2001
0 Personnel on ,2001
0 Identify Others on , 2001
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual idxntified in number (4) abOV?)
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ON OCTOBER 1ST 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 provi,sions contained in Section 2-482 of the Miami Beach City Code as amended, and all reporting
requirements. /7 11 /7
Signature of Lobbyist: {~ - L-----
rf Personally known C r"L ,\ D / 1/\ I' J / .- 0
o Produced ID ~u.... I,D;:}D -' -0 U ~ Lf \D
Identify
o Did take an oath, or
rDid not take an oath
State of Flo~.da, County of Miami- ade
Swor~~ ~I ubscri efor e
Thi~ ':f. ay 0 2002.
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If Notary, print, stamp or type as commissioned
Registration:
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FOR CLERK'S USE ONLY
[ ] REJECfED DATE: ~d<f-Od-'
2002
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