Leroy Griffith/Leroy GriffithCRy of Miami Beach Office of bqe Oty Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emall: db/derk&~cl.mlaml-beach.fl.us
LOBBYIST REGTSTRATION FORM
(Ob/of Miami Beach, Ob/Code Chapter 2, Division 3, Section 2-481)
Q Check Box if an Amendment
:14-
NAHE OF LOBBY[ST: ' (Last:) (first)/ (M.I) DATE QUALII-~cu AS LOBBYIST
BUSINESS ADDRESS: -- (Nur~ber and Street)' ' (Ob/} ! ' ' (State) (Zip Code)'
TELEPHONE NUMBER: FAX NUMBER: EMAII.:
LOBByr. ST RETAINED BY:
NAME OF PR~JC2PAL/CLIENT:
/:2?
~PHONE NUMBS:
(ob/) (state) (rap Code)
FAX NUMBER: (Optional)
EMAIL: (OpUonal)
Iqll out this secUon if principal Is a CozpomUon, Partnership or Trust [Section 2..4~2 (c)]
· NAME OF CHIEF OFFICER, pARTNEP~ OR BENEFICIARY:
· 12ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP IN1 cREST IN SUCH
SPEC/FXC LOBBY LqSUE:
Issue (o be lobbied (Describe In detail):
~.~'~'y AGENC/ESI:[NDMDUALS TO BE LOBBIED:
A) Full Name of 'rndlvldual/llUe B) Relationship
IV. D~.qCLOSURE OF TERMS AND AMOUNTS OF LOBBYL~'T COMPENSATION (D~SCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: -- ~ '~'
B) PRINC:[PAL'S DZSCLOSURE (OF LOBBY[ST COMPENSATION):
V, S~GNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBY[ST SHALL SUBMIT TO THE CITY CLERK A S~GNED
STATEMENT UNDER OATH, IAbm-NG LOBBYING EXPENDI'rURES IN THE CITY OF MT~MI 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. LOBBYIST ZD E NI'ZF.[CATION~
~/Produced ID ~ bkD - 52-~ - '3~ - IO(~ - o
Form of [denUfication
V~, ~GNA~ ~D ~P OF N~Y ~ DE~ CLX:
S~te of FIo~da, ~un~ of Miami-Dade
Sworn to and subscribed ~m me
~is ~ day of ~F~ · 2003.
~ OFRC~L N~YS~L I
/ ULLI~ B~UC~MP I
I N~ARy ~UC ~A~ OF ~A I
/ COMMI~ION NO: DDI~9 I
[] Personally Known