Maefield Development Corp.
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City of Miami Beach Office of the City Clerk R E eEl V E 0
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityclerk@cLmiami-beach.fl.U5 03 ~PR - i AM 10: 22
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-<lS1J Y CL ERK 'S OFF ICE
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o Check Box if an Amendment
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NAME OF LOBBYIST: (Last)
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BUSINESS ADDRESS: (Number and Street)
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TELEPHONE NUMBER:
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(First)
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(aty)
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FAX NUMBER:
(M.!) DATE QUAUFIED AS LOBBYIST
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CUENT:
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(Number and Street) (City)
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(State) (Zip Code)
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EMAIL: J ,~1-l, b~~ ~
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BUSINESS ADDRESS:
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EMAIL: (Optional)
FlII out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: MltA.K S, r'.(,;V
UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II. 1 SPE;:~~B:'SS~E: e.r1~'
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III. CITY AGENOES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
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A) LOBBYIST DISCLOSURE:
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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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 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~ined in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements /p .
Signature of Lobbyist:
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VI. LOBBYIST IDENTIFICATION:
CI Produced ID
Form of Identification
IJl Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to O)ld SUbsCri~m,e
This 7 tt-- day of 2002.
CARMEN A. ESTRelLA
MY COMMISSION' CC 839571
EXPIRES: September 20, 2003
Bonded Thru NollllY Public Un-'
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: [Xf ACCEPTED [] REJECTED
DATE:
'1-1-03
If rejected, state reason:
. Registration fee paid: I.')(J Yes [ ] No
[ ] Cash [Xl Check
DATA ENTRY DATE:
1
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I First Revision - 05/17/02