Abbey Hotel c/o Keith Space
JUN-Z8-Z00Z 05:03PM FROM-TEW CARDENAS RE8AK
+305536111S
T-8Z5 p.OOZI004 F-4IT
Oly of MiAIIIi lIIKh 0l'IIce of IIIe CIty Clerk
1700 '-tntiDn CanlIt DIM, MIImi \leicn. Fl Dl)9
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LOUYISr IlIGAI RATION FORM
(atv of MiamlIlUc:h, Cily COcII O\ajlter 2, DIVision 3, 5eaion 2-481)
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NAME OF LO\IIYJST: (LAst) . (Fi~~
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IlUSlNESS AIlORfSS: ~ Stteet.l (City)
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TELEPHONf NUMBER: FAx NUMBeR:
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(1''1.1) DAT! QUAIJFlEO AS LOlIIl\'lST
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NAME OF PlUNCIP"8'OJeNT: .....,
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BUSINESS ADPRE5S: (Numller IN! StrteI)
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TfLEl'HONe NUMBER:
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(CIty) (SQf4)
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FAX NUMBER: (0pti0lI1Il)
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(Zip 0Ide)
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, \~~EFOFrlC~~ aeNfFlCARY:
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Issue to lalIbied (DeScr1be in ~il):
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DJ. CRY AGi..QESIINDIVIDIW.S 'IU . LOIIIaD:
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JI.i-28-2002 05:04PM FROM-TEW CARDENAS REBAK
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+3055361116
1-825 P.003/004 F-487
IV. .,..,-.'ew......AllDAMOUIIr1SOl' Uk_.1lIJ CC1'.lPIMnOll (1lI:IiaOSl WHrntI!II HOURL r.
I'UI T IIA TE all OTH~RJ;
A) LOIIIlYIST OISCLOSlIllf:
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II) PRINOPAl'S OJSC\.05URE (OF l.Oll\IYI$T (XHI!NSAllOH):
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Oft GCnlIEl 1- OF EM:tt YUIt, Mal ~ SIW.I. su.aT101HE CD'Y Q.SUCA .as
STATEMErfI' U" CMTIt, IJSI1IIIlI L08IIYIIIG EXPEIeInJRB IN 1HE an OF MlAMlIUat I'0Il
THE PRft:Il..~_ C'.AI.EIIIMR YDR.
J do solemnly swear that all of the foregoing flIds are true and COITecI: and that I have read or am
familiar with the provislons contained in Section 2-482 of the Miami Beach Oty Code as amended, and all
reporting requirements.
Signature of Lobbyist:
SIgnature of Principal/Client:
VI. LOIImSr IDDm'I"
~ Produc::ed 10
Form of Identification
C~I~~:>
VD. SIIiIIUnUU MID sr.. 01' IIOTAIlY OR DEIIUf'( e&aIC:
State of Florida, COunty of Miami-Dade
Sworn tQ j1.~subscribect before me
This ~ '6 day of ~ . 2002.
-
POll aaut"S USE ONLY
Regl5traaon: [J ACCI!PTEO [] REJECTED DATE;
It rejec:fed, stiIbt reason:
Regis01ltion fee PilId: [ J Yes [ ] No
.l,Ji:a,~} ] CI1eck MCU
PATA ENTRy DATE: --1f-L1---- 2002 eNTERED BY:
I fitst ~lIiIion - 05117/02
JlIl-Zl-2D02 05:04PM FROII-TEW CARDENAS REBAK
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+3055381116
T-825 P.004/OO4 F-48r
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
SWORN TO AND SUBSCRIB~E ME
THIS IOU. DAY OF . 2002.
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%gn of Public No~ - State of Florida
. E1iZabe1h BenlIftIo
#"'0' =CC788873
Print, St8~ ~ Public
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The Sunshine State -
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8120-500-67-255-0
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