Ritz Plaza c/o Ignacio Contrera
..
l.D
:U
Oty of Miami Beach Office of the Oty Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cltyclerk@ci.mlami-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
.o! Check Box If an Amendment
do.in. h\OAk t30h jCNL
NAME OF LOBBYIST': (Last) (First) (M.I) DATE QUAUFIED AS LOBBYIST'
~( c .Anl~ iRlJ .II.1'CI~ lJul~'1 Ji.o C4b~/JYY \-l~ 1 ~- :5;)13\
BUSINESS ADDRESS: (Number and treet) (City) . (State) (Zip Code)
(~S) ,s.3i.-1 \ \.:2 l~S.) 53t,- 1\ (IP Odl.J?f)[elJ io ,,). ~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
, j), "-& L L j) 0 a J:.a.. "I\,... lJ On(V~.l"...LV ~fViJ..f1J /1
~AljCLIIENT: ~
lIOI ( ~JO~ ~p /LlU,
BUSINESS ADDRESS: (Number and Street)
R 30\3 9
(Zip Code)
EMAlL: (Optional)
Fill out this HCI:Ion If prindpal Is. CorporatIon, Partnenhlp or TruR [SectIon 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
? UST' ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST' IN SUCH
CORPORATION, PARTNERSHIP OR TRUST':
n. SPEaFlC LOBBY ISSUE:
Issue to be lobbied (Describe In detail):
In. CITY AGENaES/INDMDUAlS TO BE LOBBIED:
A) Full Name rtlIndlvldual/Tltle
B) IleIaIIonMlp
Ie
c
,
I
,
I
I
'I
07-28-Z002 02:50PM FROM-TEl CARDENAS REBAK
+3055361116
T-138 P.006/007 F-127
~ UI--.1.1 ...
FIAT 1M" DIt fJ'nmtr.
11
-III""
__F.."'-_
....VUISEWHEnfEIt HOlJRLY.
Aj I naa'VPiT, mcrJ.t\CIIDJ:..
1iu.s,.(Oo . t~.U~tc~
B) PRINClPAl'S DfSCLOSUIlE (OF LOlI8YIST COHPfNSAT1OH): . 00 y ~ Q. <: '" ()Pj~l => ~
...lAJ-(1 ~ 0. --r- a' U-
v. 51_lURE UtIIIIIt GllTtl;
ON OCTOIIER l--eIF fACH ftAR,. EACH LOItIlVJST5HALLS'....n m~Q.ERIC A SIGNED
sr.._. _oaTH. US11NG LOIIIJYDI8DI'I!NDnQRES IN lHE Ol'TOF MIAMI IIEAaf FOR
TllE"r~..... ~~ ,........
I do solemnly swear that aH of
flImIIilIr witlt ~ p. ..",itl\..", con
reporting requiremen~. .
Sig.I6tt.. e of lobb~ist.
egoing facts are true aM com!Ct and that I have reacI Of' am
in . 1-482 o! the Miami . e as amended, and all
SigAMur& of PrirlcipaI/Gien:
n" tu.....u" &UEftll&r&ATIOIIa
~ Produced m
Form of Identiticatldn
cI Personally Kncr.Nn
VB. SlGJlATllUAIID ~ OF "f'AIlY OR
state of Florida, County of Miami-Dade
Sworn to a~subsp'ibed before me
This '- l; I day of .... -Jv L 7 2002.
... Ct!Ia( 5_ OnLY'
Req~ation: L lACCfPTB) t..} lWECl'BL ..DAtE:.
If 1&jtCted, ...~
Atfj"'_ti(." fee po;d.t lVes-f}1'ilT'
ll~ L lChed: /00.11'
PATA ENTRY DATE: r.t I~I Or ,2002
I First'~-it5f17102
" .
,
IV. DISCI 0Sl1RE Of TERMS AND AMOUN1S OF LOI8YIST COMPENSA11ON (DISCLOSE WHETHER HOURL Y,
FLAT RATEOR OTHER):
A) LOBBYIST DISCLOSURE:
~ Z-l.~ - ~C
~J /~ lA:li
tl2.-1-.s (0/\ Q
NVJh~
B) PRINCPAL'S DISCLOSURE (OF LOBBYIST' COMPENSATION): ~ cf
----.b a..Mo W.2 ~ Gh.t (Y\V Of ,,/V) J
Y. 51&NA1URE UNDER OATH:
ON OCTOBER 1'" OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY a.ERK 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
familiar with the provisions con n
reporting requirements.
egoing facts are true and correct and that I have read or am
in S 'n 2-482 of the Miami 'ode as amended, and all
Signature of Lobbyist:
Signature of Prindpal/Client:
VI. LOBBYIST IDEN11F1CATION:
.o! Produced ID
Form of Identification
.o! Personally Known
VII. SlGfllATURE AND STAMP 01' NOTARY OR DEPUTY CLERK:
State of Rorida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 2002.
Signature of Public Notary - State of Rorida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: [] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No
[ ] Cash [ ] Check MCR #
DATA ENTRY DATE: 2002
1
I First Revision - 05/17/02
,
STATE OF FLORIDA, COUNTY OF MIAMI-DADE
SWORN TO AND SUBSC~ORE ME
THIS ~ DAY OF , 2002.
~~~~FIOrida
". '.. Elizabeth llem8Jdo
~'6""
*'fiijj{ *My eoml'li8llon CC788813
..~.... expires Augusll2, 2002
Print, stamp or type name of Notary Public