Ocean Drive Preservation Assoc.
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City of Miami Beach Office of the City Cierk
1700 Convention Center Drive, Miami Beach, Fl 33139
Email: citycler1<@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4B1)
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~ Check Box If an Amendment
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BUSINESS ADDRESS: (Nu r and Street) (City) (State) (Zip Code)
305"- S'~'.l -OSeo ?JOS"5?>/-O/SO kh"o'Wel/.sooll",,~f
TELEPHONE NUMBER: FAX NUMBER: EMAlL:
I. LOBBYIST RETAINED BY:
Oc.~Q.~ Drltlt ert'S!,"c:.I?.,~AD~a frein,
NAME OF PRINOPAL/CUENT:
Hlis Oc:.CQt\. Drtve.. M to,,,",, /3~t, I J?L "'3 '5/37
BUSINESS ADDRESS: (Number and Street) . . (Oty) I (State) (Zip Code)
30S "GO'1-~ii9'
TELEPHONE NUMBER: FAX NUMBER: (Optional)
EMAlL: (Optional)
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Fill out this section If principal Is a Corporation, Partnership or Trust [SectIon 2-482 (c)]
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NAME OF CHIEF OFFiCER, PARTNER, OR BENEFlOARY:
C.hriS Lt:t Bvt.,e.f f..
UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOUR! Y,
FLAT RATE OR OTHER).
A) LOBBYIST"DISCLOSURE:-$350 I hOU r
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST" COMPENSATION): ..
V. SIGNATURE UNDE~ OATH:
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ON octOBER 1ST OF EACH V.EAR.~' EACH l()BBvIsf SHALL SUSMIT lOTHE CiTY 'CLERK A SIGNED' "
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
, THI; PRECEDING CALENI)AR-YEAR.
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I do solemnly swear that all of the for oing facts are true and correct and that I have read or am
[amm" w"" the p,,,,,"~",, . '" T..: ~.t.he. Miami Be ch City Code as a m. ended, and a. II
reporting requirements.. "
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Signature of Lobbyist:
Signature of PrinCipal/Client: 'C ~~~~ ..;
VI. LOBBYIST IDENTIFICAnON:
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r/ Produced 10
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Form of Identification
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I:l Personally Known
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SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:! ,.
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State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of M"t . 2002.
Public Notary- State of Rorida
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Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
[ ] REJECfED
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Registration:
~~PTED
DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No
[ ] Cash [] Check
DATA ENTRY DATE:
I
.2002
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I Rrst ~Sion - OSj17j02
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