David Sacks/ A&R Sobe, LLCCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emaih dtyderk~d.miami-beach.fl .us
LOBBYZST REGZSTRATZON FORM
(CRy of Miami Beach, Qty Code Chapter 2, Division 3, Section 2-481)
~ Check Box if an Amendment
NAME OF LOBBYZST: (Last) (First)
(M.I) DATE QUAUrtt:u AS LOBBYIST
BUSINESS ADDEESS: [Number and Stree'c) (City) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: 'EMA[L:
t'. LOBBYZST RETAINED BY:
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, P~RTNER, OR BENEFICIARY:
· I_[ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORAl'[ON, PARTNERSHIP OR TRUST:
Zssue to be lobbied (Describe in detail): ~ i~;]~;f~ ~
Z]:[. CZTY AGENCJES/ZNDZV~DUALS TO BE LOBBZED:
A) Full Name of Zndlvidual/~fle B) Relationship
~ ' /
FLAT RATE OR OTHER):.
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach atv Code Chapter 2. Article VI1[. Division
Thereof Entitled "CamDaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Procurement Issues":
2)
Are vou Iobbvina on a Dresent or ~endina bid for aoods, eoui~---~t or services, or on a Dresent
or Dendina award for cmods, eauiDment or service? Yes
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chapter 2. Article V]~I Division 5
I;hcreof Entitled "Camoaien Finance Reform"· Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoalan Contributions Bv Lobbyists On Real Estate Develooment Issues":
Are YOU Iobbvina on a oendina aDDlication for a Development Aareement with the City or
annlieatln~f~r chanae of zonina mao desianaUon or chanae to the City's Future Land Use Mao?
V. SZGNATURE UNDER OATH:
ON OCTOBER 1sr OF EACH YEAR~ EACH LOBBYIST SHALL SUBMI'T TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISi~NG LOBBYING EXPENDITURES IN THE CI'I'Y OF MZAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
T do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisio~tair~,d in Sect~j~n 2 -482 of the Miami Beach City Code as amended, and all
rep°rting requireme~' / 2
Signature of Lobbyist: //~Y.~'//~ ~
n Produced ID
~orm-of ~dentification
SI~GNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of MiamkDade
Sworn. Jo~ and subscribed, I~ef~,re~ me
This Z~ day of /-4(.,4U , 2003.
/
Il ;,,~'~.~, LO~ ~, ~ lB
SigJ~ature of Public Notary - State of Flodda
Print, or type name of Notary Public
Registration: ] A~C~D
if rejected, state reason:
Registration fee paid: ~e;=[ ] No
DATA ENTRY DATE:
2nd Revision 3/18/03
FOR CLERK'S USE ONLY
[ ] .E3ECTED DATE:0-
/
[ ] Gash [ ~]'~heck HC~
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· 200~ FN'rERFD BY: / t ~.~
F:\CLER\HATL~Lobbyists~=gistrationa03.doc