MB Jewish Community Center
........ '"
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURl Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: * 12.0 /~()...
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):.p().-() f> t> J.J C'>
V. SIGNATURE UNDER OAnt:
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 50Iemnly SV/ear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions con . ed in Section -482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBB\'I5T IDENTIFICATION:
t
Produced ID fl>L #- T b Z;L -'8c2." Sb .... 3> ~ (- 0
Form of Identification
t Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me J
This 10-1'1. daYOf~~ 20P(
Registration:
[ ~PTED
FOR CLERK'S USE ONLY
[ ] REJECTED DATE:
I 110/03
{ {
If rejected, state reason: ./
Registration fee paid: [l(Yes [ ] No
~~ [Cas [ ] Check
DATA ENTRY DATE:
I
MCR # c2. S-
.1
I First Revision - 05/17/02
,oL;- ,'--",
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City of Miami Beach Office of the Oty Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@d.miaml-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4B1)
~ Check Box if an Amendment
TR.4G-ASH 70.00
NAME OF LOBBYIST: (Last) (First)
352.~ N. MI.6."11 .AVa. 'MIA,..."
BUSINESS ADDRESS: (Number and Street) (CIty)
"3C'5 S-:t I I ~ II 30'5" 5::t I I (? '2 I
TELEPHONE NUMBER: FAX NUMBER:
B
(M.I) DATE QUAUFlED AS LOBBYIST
FL- '5 ?J I Z -=l-
(State) (Zip Code)
T~'/4-S+<l A r'ct.rl-u.l-iJr,.t:;ro<.Jp
E~L: I
I. LOBBYIST RETAINED BY:
M 1A"'1.1 B 6.1.c.{.l. -I c;, kJ I ~ H. CJJtA" M UN ,TIt c..~}'..P"e:.1L
NAME OF PRINCIPAl/CUENT:
1-'z.?-1 'f'IN~T~ D~.
BUSINESS ADDRESS: (Number and Street)
'3oS S '31 "3"ZO"
TELEPHONE NUMBER:
M.1A.4 I 1> E:,6c.+{
(City)
'FL
(State)
33)10
(ZIp Code)
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section If prtndpalls a Corporation, Partnership or Trust [SectIon 2-482 (e)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFlCARY:
UST All PERSONS HOLDING, DIRECTLY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
\
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II. SPECIFIC LOBBY ISSUE:
, ,
, ,
k BJ a:.. ' P a..O.l i!:C-"
.f) E ViE/,. 0 P1Iffll1../ 1 <:>>=-
Issue to be lobbied (Describe in detail):
III. CITY AGENCES/INDMDUALS TO BE LOBBIED:
A) Full Name" individual/Title
BrRelatlonshlp
c...o M
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