Jose Zaldivar
MAV 2S- 2004 1: 16AM
HP LASERJET 3200
p.l
,
F:ECEIVED
(i
04 m,y 25 P~i 3: 22
oty of Miami ~g, ,Qfli~~/9f ij:lf-~ Clerk
1700 Convention Ce~rIOr1ve, 't.lla)rl:/~, FL 33139
LOBBYIST REGISTRATION FORM
~ISI: means liD per5Ot1$ ~oyed or retained, whelher PlIId or not, by , prIndlllll wha SIlllIc5 txl encowage the p1111i1ge, cIeIeIt
or modlllclllon fA anv ordlnllnCe, resolutton, action or dedslon fA .." commIssIOner; any 8dlon, dedslon, _1dIIIan fA the
CIty MlImlgel' III' WfI dly board or cornmll:tee; or anv lICtian, decision or recommendalkln of lII1Y cly persannd deftned In any
manner In lhls sec:ttan, during the time period of the entire declllOrHnalclng process on such aCllon, ded5ion or recommendidlon
tNt foreseeebly WlH be he8rd or rl!lllewed by the city cornmlsl5lon, or a clly board or lXll'IImltlee. The term specIflaIlly Includes the
principal IS will IS IIIIY e~ ~ed fn lobbying ac:tIYItIes. TIle.... .Labby..... .....-mc: ud...... .........,..
.. CJnIIR.:; lOO4-:J435.
NAME OF L~t\ J..!1arrt:,O"l (first) (M.I)
'1.~'( W4-J.""-'!-<1 .4\1<' 1 "^"..-,, ~, ~L ":3313q
BUSINESS NAME AND ADORESS' (Number and street) (CIty) (StallI) (ZIp Code)
~S- S"3'J..-OJ'Ob '3OS-S~l-t') r So 1c.1v.o'-' ~'el{ A~(-J
TELEPHONE NUMBER: FAX NUMBER: EMAIl:
.. LOIIIIYISUETAlNEDIn'I C". ,...."',o..uch.1lII1 rta-n, GJtA"n.~J,/tI-~~
1'0 ~ 2.ccltJt tlo.r
NAME OF PRINCIPALlaJENT:
,I./SI L,neAl,., Urrqc;,~
BUSINESS NAME AND ADORESS (Nwnber .00 StretIt)
C.1~-5"2S3
TELEPHONE NUMBER:
M,alfl,l &aJ. PI. 3g/3'J
(cay) (SlIte) (Zip Code)
FAX NUMBER: (OptIonal)
EMAJl.: (Optional)
.. out.t1111 8KIIOI\1f prIIl.' II . CorpoI'llllOll. hrtnerllllp or TnIIt [Sedfon ..-48.. (e)]
. NAME OF CHIEf OffICER, PARl'NER, OR BENEfJaARY:
. IDENTIFY AlL PERSONS HOI.J)ING, DJRECT'LY OR. INDIR.ECTl Y, A 5% OR MORE OWNERSHIP IN1EItEST IN SUCH
c:oRPORAllON, F'ARTNBWUP OR TRUST:
SPlClFIC LOBBY ISSUI!:
ef. ~ tkr I- A,
(Oesalbe In detail): c. ..cA""''l
m. CITY A&l!NClIS/JNDlVlDUALS TO BI! LCIRII!D:
A) I'I1II N_ '" .........../TItl.
II)"" ~ ......11.. or ~1I r f' ., ..........hlp
e,
MAV 25 2004 1:16AM
HP LASERJET 3200
p.2
lV. DdCLOSUIlE Of TlRMSAIlDAMOUNTS 0' LOBmST COMPI!NSATION (DlSCLOSl! WH!THIR HOURL Y,
FlATRATE OR OTHER): Jl ~ I JJ. ~
A) LOlIMSTDISCl..OSlJRE: (.....Ind)~....... ._/ .,,!JStJ 'hovr /-I-
0) PRlNCIPAL'S DISCLOSURE (Of LOBBYlST COMPENSATION): (blIuhd). 5, (){)D 13kJ Il..ofl'
v_ ~ AN ::. ..Dr -""'_ . nat..fDr-1WDfiI: lIlIH'IIeraIIon or entitY withAl. .oecYI mm..-tlon or
~ Pursuant to Ord....nce No. 2004-3435.
1)
v_ 61
2)
@ No:
V.
Pursullnt to Onfina.- No. 2003-:J393Amendlna Miami Besch Citv Olde Oaoter 2. ArtIcle vn. DIvision 5
Thereof Entitled "CamDalan Rnance Reform- Via The Addlion CI t'NtI> section 2-488 Entitled "Pmhlbit!!ld
QlIIlDIIlan Contributions By Lobbvlsts On Procurement Issues'":
AN _I.......... on a -~:::r::;- _ua-nt Dr......... or on a.. - -
ar .....una JIWIIrd far ftlftftIIIL eauiDm8ftt ar .....m?
Pu!;SUllnt to OnIi....c:e No. 2G03-3:J95 Amendina Miami ..8...... CItv Code Olaoter 2. Article VII DMsIon 5
thereof Entitled "CamDilign RnllRCe Reform.. Via The Addition Of t'ntIa 5ed:iOn 2-490 EntItled "ProhIbit!!ld
CamDlllan Contributions Bv L.obbvists On Real F-.. DeveIoDment Issues'":
==':.~:~:::-~~~:~=':~:i.:MaD?
51GNATUIU! UNDlR 0A11t:
ON OCTOBER 1n OF EACH YEAR, EAot LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
srAT!MENT UMJER OATH, LJSrING LOII8YJNG DJ:TURE5, AS WELL AS aJMPENSAUON
REiCElYl!D, IN THE crrY OF MIAMI IEAOI FOIl NG A srATEMENT
SHALL IE FILED EVEN IF THERE HAVE BEEN DURING THE
REPOR11NG PERIOD.
I do solemnly swear that all of
familiar wtth the
requirements.
Signature of LoI:lbyIst:
.tS1gnat1Jre of Prlndpal/Oient:
.-.../ ..
VI. LOIIIIYISf IDI!mFlCAnON:
o Produced ]0
:LID
Form of Identification
IIy known (LobbvIIt)
YD. SIGNATURE MD srAMP OF NCJTMY:
Form of IdentiflClltlon
X PersonaRy knawn (PI aw:ipel)
state d Rarlda, Cou1ly of MlllmHlIIde
SWom and su~ me , I
v'Tr;s~ ~ ~
~ture of Public Notary - StatB-ofRaI'lcla
lI~J
Slam d Rorlda, County of Miaml-Dilde
Swom to subsai me
This day of 20
of AorIda
lligneture
J~SDII 'R()6etr~
C.,.."..,d/" iIIi fl.' t.if'
tv,.'r~ '/1.,/,1-
'6,,,.' fiJ"It{1, "e~r., ."''1 --
'--'::- FORCURK'SUIIONLY 1.~ qt'i 10
~~~~ n,]::l~~~1A;;A~.lrat # '\ \ [)aU! Pldd
RevISed 02110/04 'F: -CLER~\MARJA-M\l.O~8Y1ST RlRM 04
'-1t;-CJL{-
~cI//-r"l)nN L 11/J./fl)~.> / Ac/~4'rS'4"s q S)/n197P..e~
-tY1T-h IfB/;?Rc:b 7'c ~tJ,j6//1f Raf"lf.fTI4...DTia/l roRI'YJ
h:; , ,be T""~ 6' 'J ~j );/).$/ t:- r- ;{J,.".",/$",/J P. /J.
,qdJeI ,JOSE .z.U"'''Ioe AT /~r / .,6'",ea,J, 7'Z;
/YJl~; ~e~J, ~j. "77~
/ff;L,,,/~rQA m/ Lc",jk a ~~
1/.' r ~
~fJ~~/~€./U1~- ~
'r~W looLf
. . 25.0. rh /
~ fl