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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, Fl33139
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AFFIDAVIT
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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 COMMITTEE; 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 FORESEEABLY WIll BE HEARD OR REVIEWED BY THE cm
COMMISSION, OR A CITY BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WEll N5 ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVrnES 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 ~TIFICATE OF WIT~DRA Al." ~___ -
1) Lobbyist Name: /(08-'7 ~~L)
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Last Name First Name Middle Initial
Business Phone -(C7/) )Jc./~ ?f? Message Phone (_)
Business Name and Address: ijo? ~//~c---~ ./:7/ _
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No. Street Suite City Stcite Zip Code
Email Address:
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Street
ifVdtC-/ /r~ Y.--J /c:?
/' / Suite
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2) Principal Retained by:
'"200 flM~J;"'4'w-
If di erent from above
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 (Descri e i Detail):
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4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: /7 / ~
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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 identified in number (4) above:
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~ined in Section -482 of the M" i Beach City Code as amended, and all reporting
requirements.
signa~LObbYist:
~erSOnallY known
o Produced 10
~take an oath, or
o Did not take an oath
Identify
State ~ ~' Coun of Miami-Dade
Sworn ubscrib re me
This day of 2002.
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If Notary, print, stamp or type as commissioned
Registration:
FOR CLERK'S USE ONLY _ . {)
REJECTED DATE:"~ / ~ d
If rejected, state reason:
Registration fee paid: ] Yes [ ] No ] Not-for-Profit Organization
[ ] Cash Check MCR #
DATA ENTRY DATE: ~~ . 2002 ENTERED BY:~ I l )