A La Folie, A Fla Corporation
Oty of Miami Beach Office of the Oty Oerk
1700 Convention Center DrIve, Miami Beach, FL 33139
Emall: dtyderk@d.mlaml-beach.f1.us
LOBBYIST REGISTRATION FORM
-
(Oty of Miami Beach, Oty COde Chapter 2, Di';1sion 3, Section 2-481)
o Check Box if an Amendment
(305) 534-4757
TELEPHONE NUMBER:
Harold
(Last) (First)
Road, PH SE Miami Beach,
(Number and Street) (Oty)
(305) 538iii5s:18
FAX NUMBER:
(M.I)
N/A
DATE QUAUFlED AS LOBBYIST
33139
(Zip COde)
Rosen
NAME OF LOBBYIST:
407 Lincoln
BUSINESS ADDRESS:
FL
(State)
EMAIL:
I. LOBBYIST RETAINED BY:
A La Folie, A Florida Corporation
NAME OF PRINCIPAL/CLIENT:
516 Espanola Way
BUSINESS ADDRESS: (Number and Street)
Miami Beach
(Oty)
(State)
Fla. 33139
(Zip COde)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [SectIon 2-482 (c)]
.
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Richard D' Ari
Oliver Corre
51%
49%
. LIST ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIO LOBBY ISSUE:
For consideration of variance for the sale of beer & wine.
Issue to be lobbied (Describe In detail):
III. CITY AGENCES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
Board of Adiustment ~ttv oL.Miami Beach
k"} 5DI
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER).
A) LOBBYIST DISCLOSURE: Attorney's fees $450.00 an hr. no lobbyist fees
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
o
V. SIGNATURE UNDER OATH:
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 contained in Se' -482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
- 11~ fl-. 4. tv/
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
a Produced ID
Form of Identification
~ Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn tp, and subscrib efore me
This eX ~ day of Uo?V'- 200
.j expires DEC. 18,2002
,,<' BONDED THRU
ATlAHllC 1I000D111(l co..INC.
Print, stamp or type name of Notary Public
<
DATA ENTRY DATE:
1
FOR CLERK'S USE ONLY , /'7 h.
[ ] REJECTED DATE: 7/ ~
Registration:
~D
If rejected, state reason:
Registration fee paid:
I First Revision - 05/17/02