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7 NAME Of CHIEI' 0l'l'ICIR. PAATNIR. CllUENI!l'lOARY: II~" II~A^,
7 US'r AU. P!RSONS I1ClLDlNCi. D1R!CTl.Y OR JNDDl!CnY, " nil OIl MORI! OWNI!IlSHIP INTmST IN SUCH
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ON OCTOIIR 1" OP IACH VIM, IACtlI.OIIVII'I' SHALL IUIMlTTO TN' CfI'Y ca._ A IlINID
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THI...-aD!NG CAUNDAR ftAR.
I do solemnly swear that all Of the foregOing facts are true and COI'I'ICt and that I have rud 01' am
familiar with the provlslons contained in Section 2....82 of the MlilmI Beach CIty Code as amended, and .n
reporting rIClUtrements.
Slgnlture of Lobbyllt:
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. Produced ID
Form of Identification
. Personally Known
YrL 1ZtMTUll.1 AND STAM' Ol"NCITAIlY OR DII'U1'Y CLIlUCt
state of Florida, COUnty of Mlllml-Dade
Sworn toArKI $ubscrlbed~:n;e
Thls~day of ~ 29
ANAMARIA GUERRA
MY COMMISSION t DO 023553 '
EXPIRES: August 28, 2005
Bonded Thill Notlry Public Underwriters
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~of Public Notary. . of Rarklll
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Print, stamp or type name of Notary Public
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Rlglltratlon: rXJ NJ;.z;.1'1 eu [] R!J!CT!D DATE:
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Rlglltnltlon fl. paid: ~ v. [ 1 No
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~ATA ~v DAre 2002 !NT!R!D BY:
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