Tucker Gibbs/Bayshore HOA
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@Ci.miami-beach.n.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o Check Box if an Amendment
NAME OF LOBBYIST:
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(Last) (First) (M.I) DATE QUAUFIED AS LOBBYIST
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(Number and Street) (Oty) (State) (Zip Code)
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FAX NUMBER:
EMAIL:
BUSINESS ADDRESS:
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TELEPHONE NUMBER:
L LOBBYIST RETAINED BY:
B/'J.;JlfiY2& IflM~ PWtVeYl.I AI Je)
NAME OF PRINCIPAL/CLIENT:
2./2-S /Vlerld~ .4v..e MIr:tM1 {J~
BUSINESS ADDRESS: (Number and Street) (City)
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(State)
(Zip Code)
3rJrr &;7'1- t/;7't-
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:
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. UST ALL PERSONS HOLDING, DIRECT1. Y OR INDIRECT1. Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR "TRUST: JJ J A
U. SPEaFIC LOBBY ISSUE:
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Issue to be lobbied (Descritie in detail):
m. aTY AGENOES/INDMOUALS TO BE LOBBIED:
A) Full Name of Indivldual{ntle B) Relationship
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lV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSA nON (DISCLOSE WHETHER HOURL Y,
FtA T RA TE OR OTHER): Ji..
A) LOBBYIST DISCLOSURE: 6;;;J fi.A-r~
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~<:; tllJ) /':?/4 ;Ct2 ~
1) Pursuant to Ordinance No. 2003-3]9] Amendin9 Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform~ Via The Addition Of Code Section 2-188 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Procurement Issues~:
:~D:~~i~::~:~Of:: aO::::~~:~i~~e~~:rb~:~~:og~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 "Camoaion Finance Reform~. Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment I55ue5~:
Are YOU lobbyinG on a DendinG aDDlication for a DeyeloDment Aareement with the City or
~~:;;on for chanae of zonina maD desiGnation or chanGe to the City's Future Land Use MaD?
V, SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG 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.
Signature of Lobbyist:
VI.
CJ Produced 10
~rsonally 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 I 7 day of r.::c-.+. . 2003,
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1G) BARBARA PAREDES
MY COMMISSION # CC 976758
EXPIRES: Nov 14, 2004
1..e00-3-NOTARY Fl NotElty ServIce & Bonding, Inc.
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Signature of Public Notary - State of Florida
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Print, stamp or type name of Notary Public
.
fOR CLERK'S USE ONLY ~. Ie.
Registration: ~ [ ] REJECTED DATE: I~' 17 d..3
If rejected, state reason: ~ ---- ~ G
Registrabon fee paid: ~ [; .N~ [ ] Cash [LJ.EI1&k MCR f9 fo Lf. '/
DATA ENTRY DATE: ~ 2003 ENTERED BY: ~
2nd Revision 3/18/03 F:\ ATl\Lobbyists\registratio~a03.dCC
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