Annual Lobbyist Registration Form MIAMI BEACH fECEIVED
City of Miami Beach DEC 04 2023
1700 Convention Center Drive
Miami Beach, Florida 33139 CITY OF MIAMI BEACH
www.miamibeachfl.gov OFFICE OF THE CITY CLERK
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Cr GV1T � r 111
Business Name: S r ad-Ci S ✓/ r
Address: / 0 ( I-. L 43 d( S p l(/UI SUS 13d-( z 0 Fh- 33O
Office Telephone Number:
Cellular Telephone Number: / S '' 3 - W6 y
Email Address: yS 14hr, 0 S -rites sm` cokl
If more than one lobbyist, please list:
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2)
3)
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5)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
/ For City Clerk's Office Use Only
MCR#: `/3 � 71
Amount paid.-57:' JU Date paid: _
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