301 Ocean Drive Condo As... (2)City of Miami Beach Office of the City Clerk
:].700 Convention Center Drive, Miami Beadq, FL 33139
Email: dtyderk~d.miami-beach.fl.us
LOBByTST REGISTRATtON FORM
of Miami Beach, City Code Chapter 2, Division 3, Secl~on 2-48:1) , ~['[' ¥; ~L ~'R~ 'S OFF ICE.
(aty
I~Check Box if an Amendment
NAME OF LOBBYIST: (~ (First) (M.I) DATE QUAMFIED AS LOBBYIST
BUSINESS ADDRESS: (Number and Sl~Jet) (City) (State) (Zip Code) · I!
TELEPHONE NUMBER: FAX NUMBER: EMAiL:
LOBBYZST RE'FA/NED BY: ,~
NAME OF PR/NC~PAL/CI..[ENT:
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMA~L: (Op~onal)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFI~EI~ PARTNER, OR BENEFIC]ARY~
CORPORATION, PARTNERSHIP OR TRUST:
SUCH
A) Full Name of Individual/Title B) Relationship
I J/-- ' - ff I~
1)
2)
Pursuant to Ordinance No. 200_~-_~_~9_~ Amendin~ Miami _Re_~h City Code Chanter 2, Article VII. Division 5
'l'h~rg~f Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled ~Prohibited
Camoaian Contributions By Lobbyists On Procurement Issues":
Ar~ YOU ~_h_hvino on a present or Dendina bid for __,~,~___=; e'"'ir"n"nt or services, or on a Dr.nnt
or ~_~_!~a award for mxxls, ~!~ment or sewice? Yes ~
Pursuant to Ordinance No. 2003-3.'~5 Amendine Miami _Be_a_~h City ct~ Chaoter 2, Article VII Division 5
th~re0f Entitled "Camoaien Finance Reform", Via The Addition Of Code __~e~d__'on 2-490 Entitled ~Prohibited
C~moai~n Contributions By Lobbyists On Real Estate Development Issues":
Are you !_,~__hvino on a oe .nd!n, m_r~_!_~_=fl,~_n for a Dev~_.~_-rnent Aareement with the City or
ha z ' r n F - H ?
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBI.4ZT TO THE CITY CLERK A SZGNED
STATEHENT UNDER OATH, I-tbi,l. NG LOBBYING EXPENDI'TURES TN THE C'[TY OF MZAH! BEACH FOR
THE PRECEDZNG 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,~ttia~ni Beach City Code as amended, and all
rep°rting requirements' ~,L ~ ..... ~'~~
Signature of Lobbyist: ·
Signature of Principal/Client:__'/~f ~-, . t~ /~__, ~..~. 0 // - ~ -'
r, Produced ID Personally Known
Form of Identification '
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ?'H~ day of ~ 2003.
· OFRCIALtI.NOTAt~y 5EA~
[ LILLIAN BEAucHAMP l
[ NOTARY pUBLIC STATE OF FLORIDA /
· CO~MmS~ON ~O. Om09~
[ MY COMMISSION EX?. APR. 29,20~ ]
Si~na~re of Public N~'tary - State of Flodd~
Print, stamp or type name of Not~ry Ptlblic
Regi~aUon: .,~ ACCEPTED
If rejected, state mason:
RegistTaUon fee paid: [ ] Yes [ ] No
DATA ENTRY DAT~:
2nd Revision 3/18/03
FOR CLERK'S USE ONLY
,2~3 E~RED ~: ~ / ]
F:~C~~i~i~03'~