Lenny Kravitz, TrusteeCRy of Miami Beach OlTIce of the City aed~
1700 Convention Center Drive, Miami Beach, FL 33139
Emalh dtyde~cl.mlami-beach.fl .us
LOBBYIST REGISTRATION FORM
(Ob/of Miami Beach, Ob/Code Chapter 2, Division 3, Section 2-481)
o Check Boxban Amendment
NAME OF LOBBYIST: '" (Last:) / (First)
(M.i)
DATE QUAI.~P~cu AS LOBBY[ST
(zip ;;:~e) -
EMAIL:
x. LOBBY~'T RETAINED BY:
NAHE OF PR/NC[PAL/O.IENT: (
/~I~S~N-ESS ADDRE~S: - (Nunfber and gaeet) / (OW)
'TELEPHONE NUMBER: FAX NUMBER: (Optional)
EHATL: (Op~ofial)
Fill out this section If pdncipal is a CorporaUon, Parl~er~hip or Trust [SecUon 2-482 (c)]
· NAME OF CHIEF OFF~CEP~ PARTNER, OR BENEF[C/ARY: /~/-'~ ¥ ~/''~IT'Z'-'~ /'/"~'~ //~"'
· LIST ALL PERSONS HOLDING, DIRECTLY OR [,ND~,ECTLY, A 5% OR MORE O.,.~_.~IP INTEREST IN SUCH
CORPORAT[ON, PARTNERSI'LTPORTRUST:/~ _., _~ ~,q
SPECiFiC LOBBY ISSUE:
Issue te be Idbbied (Deso'ibe in detail):
III. ~-~i¥ AGENC~ES/ZNDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
I'V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYTST COMPENSA1/ON (D~.qCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER): ~
B) PRZNC~PAL'S D]SCLOSURE (OF LOBBYZST COMPENSAT]ON~:~(,~ ~ ~/
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMI'I' TO THE CZI'Y CLERK A SZGNED
STATEMENT UNDER OATH, LlrSTZNG LOBBYZNG EXPENDI'rURES I'N THE CI'TY OF M/AM[ BEACH FOR
THE PRECEDING CALENDAR YEAR.
! do solemnly swear that all of the foregoing facl~ am true and correct and that ! have read or am
familiar with the provisions contained inSectJo~-482 of the [~ami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
o Producod ID ~emonall¥ Known Form of Identification
S~GNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami'Dade
Swom b3 and subscribed before me
This ~O_~/~lay of '~o cji_ . 2003.
IoFFICIAL NOTARY SF~L I
LILLIAN BEAUCHAMP
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DD~09/89
My COMMISSION EXP. APR. 29,2006
'Sigi~ature of PuJ~tc Notary - State of'Florida
Print, stamp or type name of Notary Public
~D/ FOR CLERK'S USE ONI.Y /. .
~ Re, or1 ~/27/03 F:\C~HATL~.obby~sts\regls'a'a~onO3.doc