A Nanny Blue Knight & Co.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cltyderk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o Check Box if an Amendment
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NAME OF LOBBYIST: (Last)
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BUSINESS ADDRESS: (Number and Street)
()Clo)) /8'1- 1 '71 J-
TELEPHONE NUMBER:
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(First)
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(City)
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(M.I) DATE QUALIFIED AS LOBBYIST
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(State) (Zip Code)
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EMAIL:
FAX NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CLIENT: , I
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BUSINESS ADDRESS: (Number and Street)
(3'5) ~(- 21f~:5
TELEPHONE NUMBER: FAX NUMBER: (Optional)
MI'"'''' ~t"'~
(City)
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(State)
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(Zip Code)
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EMAIL: (Optional)
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,F'II ,out this section if principal is a Corporation, Partnership or Tru~ [Section 2-482 (e)] \
. ," . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: b ~, {' ~v ~t.N t:"v,..( l
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LIST ALL PERSONS HOLDING, DIREffi Y OR INDIREC!T1. Y, A 5% OR MORE OWNERSHIP INTliRf$T IN SUCH
CORPORATION, PARTNERSHIP OR lRUST: C., \ l' LA'" lit vV tCl~ II
II. SPEOFlC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
m. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
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IV. DISCLOSURE OF TERMS ANO AMOUNTS OF LOBBYIST COMPE SATlON (DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHER): 1_ u II r/
A) LOBBYIST DISCLOSURE: nv 'J1 V
B) PRlNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): f 1U ()
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1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian finance Reform" Via The Addition Of Code Section 2-188 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Procurement Issues":
Are YOU lobbyinG on a Dresent or DtmdlnG bid for Goods. eauiDment or services. or on a Dre5ent
or Dendlna award for Goods. eoulDm~nt or service? 0 Yes ~o
2) Pursuant to Ordinance No. 2003-33~5 Amendino Miami Beach City Code ChaDter 2. Article VII DiYision 5
thereof Entitled "Camoaian Finance Reform". Via The Addition pf Code Sf;!ction 2-490 Entitled "Prohibited
Cainoaian Contributions BY LobbYists On Real Estate DeyeloDment Issues":
A", you,lobby!nG on a DendinG aDDncation for a DeYelopmen~ AGreement with the City or
aDDncation for chanae of zonina maD desiGnation or chanGe to the City's Future Land Use MaD?
DYesD~
V. SIGNATURE UNDER OATH:
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ON OCTOBER lilT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT Tel THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. ;
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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 all
reporting requirements.
[J Produced 10
Signature of Lobbyist:
A Signature of Principal/Client: #
VI. LO.BYIST IDENTlFICATION:
Form of Identification .
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ar.d day of ~ 2003.
MAIlI.ENE MElENDEZ
MY COMMISSION _ CC 952916
EXPIRES: July 4, 2004
Bondedl1>1UNowy_U__
te of Florida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: [vrACCEf1reD
) REJECTED
DATE:
toJ 2./03
If rejected, state reason:
Registration fee paid: ~es [ ] No
DATA ENTRY DATE: I D/I..'3
I
[ ] Cash [~eck MeR II 24'"1-1 +a
,2003 .....RED BY,~
F:\ R\HATL\Lobbyists\registrationa03.doc
2nd ReviSion 3/1B/03