1st Meridian Properties LLC
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City of Miami Beach Office of the City Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerk@d.miami-beach.fl.u5
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) ";; T
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS ADDRESS: (Number and Street) (City)
TELEPH~2MtR:4'? r 7 FAX NUMBER:
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DATE QUAUFIED AS 1::66& "" I
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(Zip Code)
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I. LOBBYIST RETAINED BY:
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NAME OF ~RlNaPAl/CUENT:
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BUSINESS ADDRESS: (Number and Street)
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(City) (State)
(Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if prindpalls a Corporation, Partnership or Trust [SectIon 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. UST ALL PERSONS HOLDING, DIREffiY OR INDIREffiY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPE~.BBYISSUE:
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Issue to be lobbied (DeScribe in detail):
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III. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A} Full Name of Individual/Title
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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 Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements. ~ ~
Signature of Lobbyist: ~
Signature of Principal/Client:
VI.
a ProducedID YDLt=l= KSOl")-ooO- 52-1l.{2.- 0
Form of Identification
a Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This l.rr day of f'-JcoJt./--Ibe..r . 2002.
OFFl NOfARYS
ULLIAN BEAUCHAMP
NOfARY PUBUC srATE OF FLORIDA
COMMISSION NO. DOt09289
MY COMMISSION EXP. APR. 29.2006
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s~~otary~~
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Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: ~ ACCEPTED [] REJECTED
If rejected, state reason:
Registration fee paid: ffies [ ] No
~sh [ ] Check
DATE:
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DATA ENTRY DATE:
1
MCR # 1S'" 'i,;~
2002 ENTEREDBYt?5" I jJ
1 First Revtslon - 05/17/02