H. J. Ross
~
-
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk@ci.miami-beach.f1.us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINCIPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR DECISION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY cm BOARD OR COMMmEE; OR ANY 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 FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMmEE. THE TERM SPEClFICALL Y INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTlvmES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAW? AS A
LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL." r-
1) Lobbyist Name: ~4l~~ t)CM.G'IJQ ~ 1
Last Name First Name Middle Initial
Business Phone eO r) "Iv / -Il 7 Z. Message Phone (_)
Business Name and Address: ~t./K- IS 11/1 L <;tXtf, L. L C
1&05 5"LJ 't 57 'VJ~ t, 1--,,4/)1, f\... 5)11")"
No. Street Suite City , State Zip Code
Email Address:
2) Principal Retained by: ;';.J. toss
J,lo 50 ? 5, UJo
I
. Suite
If different from above Street
CO~ G Iw.1 us> r1- J 513 'i
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):
(:>"6 'N~OC(,..J G
eo!'l-rAA4c... 7 ("
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: S' /' _ {" _ J
7;:r;:,c .../- LPl)nlSJ/orv
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
Cl//IJ
Cl The City Commission
Cl City Commission Subcommittee
Cl City Staff
Cl City Board or Committee
Cl Personnel
Cl Identify Others
.2001
,2001
,2001
.2001
, 2001
,2001
on
on
on
on
on
on
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above:
;VO N~
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 provisions cont?lined in Section 2-482 of the Miami Beach City Code as amended, and all reporting
requirements, /': A'" J
Signature of lobbyist: ~~ - " (.)
Cl P~lIy known tl.
~oduced ID U 'y10 - ofo' r6l.f l1 - 0
_____ Identify
~Did take an oath, or
Cl Did not take an oath
State of Florida, County of Miami-Dade
Swor~ aIlE sUbscri~e~.orr:e m mee ')nn
This~dayof ~2.
~~
If Notary, print, stamp or type as commissioned
Registration: [~~
[ ] REJECTED
FOR CLERK'S USE ONLY
DATE: S"-l-o d-
If rejected, state reason: ______
Registration fee paid: r1'Yes [ ] No [] Not-for.-~~~~.
[ ] Cash [ ] Check MCR If, ,....,....,
DATA ENTRY DATE: ~- / . 2002 ENTERED BY: f:j .