301 Ocean Drive CondoOb/of Miami Beach Office of the Oty Oerk
1700 ConvenUon Center Drive, Miami Bea~, FL 33139
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LOBBYIST REGISTRATZON FORM
(City of Miami Beach, Ob/Code Chapter 2, Division 3, SecUon 2-481)
~C_heck Box · an Amendment
(M.I) DAT~ (~IALu-?-u AS LOBBYIST
BUSINESS ADDRESS: (Number and Street) (Ob/) (State)' (Zip Code.) -- /
G 5'Z-c _coo 5GI-OI. "O
TELEPHONE NUMBER: FAX NUMBER: EF'U~L:
BUSINESS ADDRESS: (Number and Street) (O~'y) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (OpUonal) EMAIL: (OpUonal)
FIll out this sec'don · prindpal is a CoqxwaUon, Partnership or Trust [Section 2-482 (c}]
· JqA~4E OF CHIEF OFFICER, PARTNER, OR BENEJ~CIARY:
· LIST ALL PE~S HOLDING, DIRECTLY CrR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
*rn'. CITY AGENCI~S/~NDIV~DUALS TO BE LOBBIED:
A) Full Name of IndivkJual/Title B) Relationship
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Cit~ Code ChaDter 2, Article VII, Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 EntiUed "Prohibited
Campaiqn Contributions By Lobbyists On Procurement Issues":
2)
Are you Iobbvinq on a Dresent or Dendinq bid for ~oods. eeuiument or sewice~, or on a present
or pendinq award for qoods, euuiDment or service? Yes ~
Pursuant to Ordinance No. 2003-3395 Amendine Miami Beach City Code Chaoter 2, Article VII Division 5
thereof Entitled "Camoaien Finance Reform", Via The Addition Of Code Section 2-490 EntiUed "Prohibited
Campaiqn Contributions By Lobbyists On Real Estate Develonment Issues":
Are YOU Iobbvinq on a Dendinq aDDlication for a DeveloDment Aoreement with the City or
apD!~C~_for chanqe of zoninq mad desiqnation or chanqe to the City's Future Land Use MaD?
V. SZGNATURE UNDER OATH:
ON OCTOBER 1~r OF EACH YEAR, EACH LOBBYIST SHALL SUBMI'I' TO THE CITY CLERK A SI*GNED
STATEMENT UNDER OATH, 1 lbi,NG LOBBYING EXPENDITURES TN THE cI'rY OF MZAM! BEACH FOR
THE PRECEDI'NG CALENDAR YEAR./
! cio solemnly swear that all.~ th~fforegol, p~,~/are/true and corr.,~-~d that ! have read or am
familiar with the provisio,~coi~ned in Fect. io~ t-'$82 of the Mi~f Beach, City Code as amended, and all
reporting requirementsJ,~/,.~.
Signature of Lobbyist' ,j( O~vT(j / - - -----'~r r-)NJ v
o Produced ID ____
Form of IdenUfi~tion
V1/. SXGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Flodda, County of MiamkDade
Sworn to and subscribed before me
This r~)[ rr day of ~U./()~¥! .2003.
LILLIAN BEAUCHAMP
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DD109289
MY COMMISSION EXP. APR. 292006
ure of P-ublie~bll~tary - State of Flor(da
'
Print, stamp or type name of Notary Public
Regisb'aUon: [k~ACCEPTED
If rejected, state rea~n:
R~i~aUon ~ paid: [ ]~ [~
DATA E~Y DA~:
/
2nd Revision 3/18/03
FOR CLERK'S USE ONLY
[] DATE:
/
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F: \~l~HATL\LobbyistsyegistraUona 03 .doc