Alfredo Gonzalez/David's Cafe LOBBYIST': (L,~:)
I O coif Colliqs ~,~
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BUSINESS AOORESS: (Numl~r a~ ~e:) (Ot~)
T~ [~,.101~ NUMBER: ~ NUHBER:
BUS~NESS ADDRESS:
(Number and ~.met) (C:~)
F-AX NUM~,: (OpUonM)
(Sine) (:~p Code)
~s~tL: (o1~)
Fil ~ U~m Nd~m ~ FkKkM k ~ C~qwrMi~, ~ ~ Tnmt [SedJm 2-M3 (c)]
· L~ST ALL I~RSOflS HOt. D~NG, DIREL-rLY OR ~NDIRECTLY, A 5% OR MORE OWNE3tSH/P ~ i I~'T IN SUO'I
CORPORATION, PAKTNER..qH~P O~ TRUST:
ZSSt~ m be Io~led (Des~lbe in demi):
A) LOeB'fiST D[SO. O6URE: ~ ~
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YF. AR~ EACH LOBBYIST SHALL SuBIqXT TO THE C3TY a. ERK A SIGNED
STATEMENT UNDER 04111, I.bt zfdG LOBBYXNG EXPENDZTURES XN THE,,.J.,Y OF MIAHX BEACH FOR
THE PRECEmNG CALENDAR YEAR.
X do solemnly swear that all of the ~'o~egoiflg facts are true and correct and that X have reed or am
Section 2-482 of the Miami Beach C~ Code as amended, and all
familiar with the provisions ~ontain~l in
Signature of Lo~
[] Produced ID
Form of Iden'dfication
Swom to and subscribed before me
This "~\ . day of ,~-~ , 2003.
1[MY COMMISSION tt CC 848243 Ii
EXPIRES: Octobe~ 22, 2003 J~
I~Jonally Known
Signature of Public Notary - SLa~: of Florida
Print, stamp or type name of Notary Public
If ~, ~ reason:
~gl~_'-_--~ fee paid: [ liyes [ ] No
/
2nd Revis~ 1~27/03
A) L~ Dt.~:j.C35UI~: ~ ---"
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST C~TION):
Produced ID
Form of Identification
{;~ersonally Known
VII. SIIINATURI AND STAMP OF NOTARY OR DBqTY C:L~RK:
State of Florida, County of Miami-Dade
Swom to and subscdbed before ~
This, ~\ . clayof ~,L~ . ,2003.
Signature of Public Notary - State of Flodda
Print, stamp or type name of Notary t>ublic
If ~Jt~__~, m reason:
2nd Revision 1127103
[ ] P,E:JECT~ DATE:.J
[ ]Cash [ ]Check ~., '.
F:~3.ER~TL~.ol~¥egistralJon03.~