Stuart Smilow
~
.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Bach, FL 33139
Email: cityclerk@cl.mlami-beach.ft.us
LOBBYIST REGISTRATION FORM
RECEIVED
02DFC 19 Pr~ \.;: 34
Gir', :.;U::RPi'S OFF ICE
.
...,
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o .05 Check Box If an Amendment
NAME OF LOBBYIST:
Bercow
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard Suite 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
(305) 377-6220
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
EMAIL:
I.
LOBBYIST RETAINED BY:
Stuart Smilow
NAME OF PRINCIPAL/CLIENT:
4465 Sheridan Street
BUSINESS ADDRESS: (Number and Street)
509-267-4919
TELEPHONE NUMBER:
Miami Beach
(City)
Florida
(State)
33140
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership. or Trust [Section 2-482 (e)]
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY:
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Aoolication
Issue to be lobbied (Describe in detail):
III. CITY AGENCIEs/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvlduallTltie B) Relationship
JorQe Gomez None
Armando Valdes None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE:
Hourlv $400.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
Hourlv $400.00
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
PRESEDING CALENDAR YEAR.
r. e and correct and that I have read or am
of the Miami Beach City Co e as
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o .of Produced ID
Form of Identification
<Ci .of Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
8 Ylmet Godoy
I'-.ron 1# DD08815?
\t I!IpIRs JcID. 31, 2006
AImIl!folaly
n ,l.soo.3sc.5161
State of Florida, County of Miami-Dade
Sworn to and s~ed before me
This 2. day of , 2002.
Print, stamp or type name of Notary Public
Registration:
FOR CLERK'S USE ONLY
OI(ACCEPTED [] REJECTED DATE: I 2.~ I q ~ 0 1-
If rejected, state reason:
Registration fee paid: l>QYes [ ] No
~[ 1 Cash J>{Check
MCR# ')-S7Lt \ 0
DATA ENTRY DATE:
1
, 2002 ENTERED BY:
1 First Revision - 05-17-02
.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLAT RATE OR OTHER):
#rn -( I Y IIfOO .00
A) LOBBYIST DISCLOSURE:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
V. SIGNATURE UNDER OATH:
ON OCTOBER 18T 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
PRESEDING 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 PrincipaVClient:
fl-/ $
VI. LOBBYIST IDENTIFICATION:
~~ Produced ID 55110-':19(/ -?dr:2.5 3- 6
Form of Identification
o ~ Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 1!1- day of Dit'l Yflb42002.
Signature of Public ary State of Florida
Li6'a.m R fJqj p.,'dd
Print, stamp or type name of Notary Public
,<JS'" Llllam R Hatlleld
. ,~ . My Commlaslon DOOO202G
V,"f':/ Expires February 18, 2006
FOR CLERK'S USE ONLY
Registration:
KACCEPTED
[ ] REJECTED
DATE:
12..-lq~~'l
If rejected. state reasll!!: ~
Registration fee paid: pt"Yes [ ] No
[ ] CashXCheck MCR #
'L.511.{IO
DATA ENTRY DATE:
1
, 2002 ENTERED BY:
1 First Revision - 05-17-02
\