Gigi Carrier Cowell
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@d.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4Bl)
o Check Box if an Amendment
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NAME OF LOBBYIST: (Last)
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BUSINE ADDRESS: (Number and Street)
(30$ tOL ... "1tl2
TELEPHONE NUMBER:
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(First)
W\ t"lAAi
(City)
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FAX NUMBER:
(M.I) DATE QUALIFIED AS LOBBYIST
FL. ~ ,/5 f
(State) (Zip Code)
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EMAIL:
I. LOBBYIST RETAINED BY:
b i~ i C A.V';-lvf ~CtWc,~\
NAME OF PRINCI~L/CLIENT:
:;> :)GX> ~ Atx.
BUSINESS ADD~S: ~r and Street)
(1~S) -S~l- 2-82-5
TELEPHONE NUMBER: FAX NUMBER: (Optional)
M1~i B(.ciA
(City)
f~'~ . ,..:l-
~:te) (Zip ~~) ( lfL-
EMAIL: (Optional)
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Fill outthis section if prineipallsa Co~ratlon, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. LIST All PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR 1RUST:
II. SPEaRC LOBBY ISSUE:
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Issue to be lobbied (Describe In detail):
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III. arv AGENaES/INDMDUALS TO BE LOBBIED:
A} Full Name of Individual/Title
. B} ReIatIonstilP'~ ...'
'IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENS
Fl.A T RA TE OR OTHER); i ":< (; (;
A) LOBBYIST DISCLOSURE: /
nON (DISCLOSE WHETHER HOURLY,
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B) PRlNOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): tt
1) Pursuant to Ordinance No. 2003-3393 Amendina 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
Camoaian Contributions By Lobbyists On Procurement Issues":
:~~:~~i~ab:~:~dOf~: ao::::.n:;~i~"e~~:rb~:~~:O~~e~~ent or services. or on a Dresent
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reforn:!". Via The Addition Of Code Section.2-490 Eintitled "Prohibited
, Camoaian Contributions By Lobbvists On Real Estate Develooment Issues": '
Are YOU Iqbbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or
~~=~ for chanae of zonina maD desianation or chanoe to the City's Future'Land Use MaD?
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V, SIGNATURE UNDER OATH:
. .
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ON OCTO.BE~ 1ST OF EACH YEAR, EACH LOBBYIsT SHALL SUBMIT TO THE 01Y CLERK A SIGNED
STATEMENT UNDER OATH, UsnNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI 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 all
reporting requirements.
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VI. LO.BYIST IDENTlFICATlON: - - /
CI Produced ID M' Personally Known
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 :;Lttd. day of ()el1J lur . 2003.
Signature of Public Notary - State
Q) MARLENEMELENllEZ
". ,. MY COMMI SSION # CC 952916
I . EXPIRES: July 4, 2004
__NoIoIyPublloUndllWrilon
.
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Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration:
[~CCEPTED
] RElEcn:D
DATE:
j f) j '2-/1)3
.
If rejected, state reason:
Registration tee paid: (loi"Yes ) ] No
DATA ENTRY DATE: (t) 1r3
2nd Revision 3/1B/03
[ ] Cash [-.J.Oieck ~'_ 2- "'-f'I 'f-e
.2003 ENTERED BYV' ~
F:\ClfR\HA Tl \LobbyiSls\registrationa03.doc