304 Ocean LLCOb/of Miami Beach Office. of the Ob/Oerk
1700 Convention Cen~er Drive, Miami Beach, FL 33139
Emaih cit~ci.mlami-beach.fl.us
LOBBY/ST REGXSTRAT[ON FORM
(Ob/of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
a Check Box ifan/~mendment
NAME OF LOBBYIST: v -CLas~)
BUSINES~ ADDRESS. * (Number and Street)
TELEPHO-NE~UME~ER: FAX NUMBER:
(aty)
(M.X) DATE QUALIFIED AS LOOB¥i~T
(S~L~) /' (Zip Code)
LOBBY]ST RETA.TNED BY:
NAME OF PRINC[PAL/CI_[E~:
BUS, ESS ADDRESS: (Num~ber and Street~ ' (aty)
/
TELEPHONE NUMBER:
- ~ (Sfl;ate) (Zip Code)
FAX NUMB~-~: (Optional)
ENAiL: (OpUonal)
RII out this sec'don if principal is a CorporatiOn, pai~h'ership or Trust [Section 2-482 (c)]
· L/ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,. A 5% OR MORE OWNERSHIP INTl~ IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ' , ' '
SPECiFiC LOBBY ZSSUE:
Issue b3 be lobbied (Describe in detail):
AGENCXES/'rNDI'WDUALS TO BE LOBBI'ED:
.:
·
A) Full Name XndMd~al ~"
B) Relationship
ZV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBY]ST COMPENSA'rZON (DZSCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYZST DTSCLOSUR_E: ~.~ (~ ~._.. ,/"J-~..4f'/-, ,.,_ ' .
B) PmNCZPAI.'S DTSCLOSURE (OF LOBBY'ZST COMPENSA'r]:ON): ....:?~ ~,. ~ ¢ j,,,'- ,/"'r-~ r-
V, SZGNATURE UNDER OATH:
ON OCTOBER 1sr OF EACH YEAR, EACH LOBBYZST SHALL SU'BMI'r TO THE CTI'Y CLERK A S/GNED
STATEMENT UNDER OATH, LZST/NG LOBBY"J[NG EXPENDI'rURES ZN THE CI'TY OF MZAM! BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions contained in Se~n 2-a,82 of the Miami Beach City Code as amended, and ali
reporting requirements. ~_"'_.....fS'/~~.~ _ ·
Signature of LobbYist:
Signature of Principal/Client:
VZ. LOBBY]ST XDENTZFZCA'rZON:
Produced TD ~ ~ ~¢~ -(7 & ! ~-- ~, C2 2, ¢~
F6"~m o'f TdenUficaUon
[] Personally Known
SZGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami'Dade
Swom to and subscribed before me
This ~ .day of I~A.x,~ , 2003.
Expires February 18, 2005
'Print, stamp or type name of Notary Public
Registration: ~~~'D
If rejected, state reason:
RegistraUon fee paid: [ ~ ] No
DATA ENTP,¥ DATE: ,..._1~/
2nd Revision '1/27/03
..