Narcisse
"
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RECE1VED
03 riPR 30 PH 2: 52
City of Miami Beach Office of the City Clerk .'" T Y C L E R K 'S 0 F FIe E
1700 Convention Center Drive, Miami Bach, FL 33139.J
Email: cityclerk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
~
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
D Kf Check Box if an Amendment
NAME OF LOBBYIST:
Larkin
(Last)
Michael W.
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. BISCAYNE BLVD.. SUITE 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
EMAIL:
I.
LOBBYIST RETAINED BY:
Narcisse
NAME OF PRINCIPAUCLlENT:
710 North Clark Street
BUSINESS ADDRESS: (Number and Street)
Chicaao.
(City)
Illinois
(State)
60610
(Zip Code)
(312) 787-2675
TELEPHONE NUMBER:
(312) 787-0128
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership, or Trust [Section 2-482 (c)]
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY:
Jay Vohra
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Administrative Aoorovals and Conditional use oermits
Issue to be lobbied (Describe in detail):
III. CITY AGENCIESIINDlVIDUALS TO BE LOBBIED:
A) Full Name of IndividuallTitle
B) Relationship
Citv of Miami Beach Plannina Board
NONE
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURL Y, FLA T RA TE OR OTHER): /1
A) LOBBYIST DISCLOSURE: Hourlv I ~.'P / h r ..
.{
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION):
Houri
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
PRESEDING 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 contain i ection 82 of the .ami Beach City Code as
amended, and all reporting requir:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
D 2S Produced ID
Form of Identification
.~ 2S Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
........
': ..~~"MJ", LISA C. BROOKS
": l~l:""'~~,{~ MY COMMISSION # CC 856829
-.. .-
~~. }.,1 EXPIRES: July 20, 2003 .
..,1.~',,,'~~' Bonded Thru Notary Public Underwnters
"',,'lflt~' '
State of Florida, County of Miami-Dade
Swom to and s~~red before me
Thi~ day of , 2003.
ck~
Signature of Public Notary - State of Florida
Print, stamp or type name of Notary Public
Registration:
FOR CLERK'S USE ONLY
'f:l ACCEPTED [] REJECTED DATE: It -30 '- 0 "3
If rejected, state reason:
Registration fee paid:~es [ ] No 1\ (_ \. ~() ~_
[ ] 7h l<tCheck MCR # A'(}
PATAENTRYDATE: ~.'O ~ ENTERED BY: )
1 First Revision - 05-17-02
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
v. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf 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 contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Signature of Prindpal/Client:
VI. LOBBYIST IDENTIFICATION:
CJ Produced ID
o Personally Known
Form of Identification
VII. . SIGNATuRE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 2003.
Signature of Public Notary - State of Florida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: [] ACCEPTED
[ ] REJECTED
DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [ ] Cash [ ] Cleek MCR #
DATA ENTRY DATE:
. 2003 ENTERED BY:
2nd Revision 1/27/03
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