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Lauren Weiner/Art Basel t. . Oty of Miami Beach Office of the City Oerk 1700 Convention Center Drive, Miami Beach, FL 33139 Email: cityderk@d.miami-beach.fl.us LOBBYIST REGISTRATION FORM RECE\VEO 03 NO\l24 AM \0: \ 3 cITY CLERK'S Off ICE m - (Oty of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) [J Check Box if an Amendment W CIi1e Laure .11- NAME OF LOBBYI : (Last) (First) (MJ) DATE QUAUFIED AS LOBBYIST 3// L/n(d/n J2~ ,1171()/r7/' /~eacf'), j::L- 3 ~/"Y7 BUSINESS ADDRESS: (Number and Street) , (City) (State)' (Zip Code) 78& .2S3.322C::;- 305 .(pd4- .crt73 LttVetne>Rarihc<s.f?(,(O(1- TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 1Ir-l- I3t1Ys-e I Ih/~U'h/ &a:Ch NAME OF PRINOPAl/QlENT: 31'7./~IJLI. 0737 TELEPHONE NUMBER: mlam" /Yael, 1Ft 33/31 (State) . (Zip Code) 305 .&o4-.&Jq7~ FAX NUMBER: (Optional) 3/ / L/n coin 1!d. Su/ k 3/0 BUSINESS ADDRESS: (Number and Street) (City) .-- EMAIL: (Optional) Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (e)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFIaARY: UST ALl PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUOi CORPORATION, PARlNERSHIP OR TRUST: n. SPECIFIC LOBBY ISSUE: VC!+ bra-nl- Issue to be lobbied (Describe in detail): m. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Relationship {/qC CAr ~ -h ho~ I-; . 1.Y. U.I.;:K..LU:KJtU: ur I CKPI:IIArtu "....UU....;:) ur LVDDI .1.;:)1 ....VM~CI'C:N\I.lV... \UJ.:::M....LV:JC nncl ncn. nVVf(L', FLA T RATE OR OTHER): A) LOBBYIST DlSCLOSIlRE: I t1 er B) PRINQPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): fi s;eL.~ 1) Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach Citv Code Chaoter 2. Article VII. Division 5 Thereof Entitled "Camoaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaiqn Contributions Bv Lobbvists On Procurement Issues": nt or services or on a resent 2) Pursuant to Ordinance No. 2003-3395 Amendinq Miami Beach Citv Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaiqn Contributions Bv Lobbvists On Real Estate Develooment Issues": ? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING 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: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Q Produced ID J')r '\ ve..tS I j elf' X)Le.. Form of lrentification Personally Known VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade Sworn to and sUbscri~ ~fore me This ..ati.--day of [)\J. . 2003. r ~~~~ Signature of Public Notary - State of Florida ",'j::"~ Marma Blueslone Print, stam;M;;~=:;t;;;PUbliC FOR CLERK'S USE ONLY Registration: .K:[ ACCEPTED If rejected, state reason: Registration fee paid: ~es, [,] No [ ] Cash ~ MCR DATA ENTRY DATE: ~ 2003 ENTERED BY: 2nd Revision 3/18/03 [ ] REJECTED DATE: _{l~Q..Lf-03 'lbc;3JQ / HAll.\Lobbyists\registrationa03.doc