Villa Luisa (2)City of Miami Beach Office of the Oty Clerk
1700 Convention Center Ddve, Miami Beach, FL 33139
Email: cityderkOci.miami-beach.fl.us
LOBBYZST REGZSTRATZON FORM
(City of Miami Beach, City Code ChaPter 2, Division 3, Section 2-481)
Check Box if an Amendment
NAME OF LOBBYIST: (Last) (First)
BUSINESS ADDRESS: (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER:
(M.I) DATE QUALIFIED AS LOBBYIST
(State) (Zip Code)
EMAIL: ~
I. LOBBYZST RETAINED BY:
V,~o, ~,so. L~c ,,J~ ~'o~f t~~ (ort~
NAME OF PRINCIPAL/CLIENT:
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: 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, OR BENEFICIARY: ~le[~ f'Sb
· LIST ALL PERSONS HOLDING, DIRECTLY OR INDIP~.ECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: g, ~:,/C~l~4b~.~. ~'~ g..,~
II. SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
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OrH;,O.
A) LOBBYJS'T'DZSCLOSURE:
B) PRZNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSAT~ON~.'~([~' ~
1)
2)
Pursuant to Ordinance No. 2003-3393 Amendina NJami Beach City Code Chapter 2. Article V~I. Division 5
Thereof Entitled ~Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled 'Prohibited
Camoaian Contributions Bv Lobbyists On Procurement 1~ue~":
Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2, Article V~I Division 5
thereof Entitled 'Camopion Finan~;? R?form', Vip The Addition Of Code Section 2.490 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Real Estate Development Issues":
Are you Iobbvina on a Dendina aDDlicaUon for a DeveloDment Aareement with the City or
application for chanae gf ~onina maD desianation or chanae to the City's Future Land Use MaD?
nYes ~'~1o
V. SZGNATUREUNDEROATH:
ON OCTOBER 1~r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE cI'rY CLERK A SIGNED
STATEMENT UNDER OATH, Lib 1 lNG LOBBYING EXPENDI'rURES TN THE CITY OF MZAMI* 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 ali
reporting requirements. /1 /~ ~
Signature of LobbyJst: ~l//,. 'V .~//~' ' ....
~' Signature of Principal/Client:(/- '-T'~/~ ~
VI. LOBBYIST ZDENT/FICATZON:
Form of IdenU~caUon
SIGNA~RE AND ~P OF NOTARY OR DE~ CLE~:
State of Florida, Coun~ of Miami-Oade
Sworn to and sub~Hb~ be~re me
~is I~ day of ~~ . 2003.
LILL~ B~U~MP J
COMMI~O~ ~O, Om~
~X CO~tSS~O~ ~XP. A~
[] Personally Known
Print, stamp or type nam~ of Notary Public
RegistraUon: ['~i t~D [
If rejected, state reason: ,.~
Registration fee paid: [~[~No
DATA ENTRY DATE: ~/J'-"Z.~'
2nd Revision 3J18/03
FOR CLERK'S USE ONLY
] RE.1ECTED DATE: ~" I"~---'~(~
[ ]Cash [ ]Check NCR# ,"~
,2003 ENTERED BY: ~
F:\C~HATL\Lobbyiff~\regiffffatio~O3.doc