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Ira Nusbaum/MB Watersports JUL-2B-2004 05:25 PM SHANE WATERSPORTS CENTER 305861BB41 P.04 Qty of Miami Beach otflce of the City Cfet1c: 1700 Convention Center Drive, Miami Beach, FL 33139 LOBe\'lST REGJS'I1tATION FOaM ~~ \11\ 0 lU\)~ ~1~ -- 'I -- l..obbylSt - .. .-- ernpto~~ 01' ~ whaIINr ..Ill tW lICIt, by . princiPII who ... ID _011..... dle ....... oWuI: or modll'lclrllon ~ lit, ordfnMCe, _1Utlon, IctiClll tW cIedsJon tlf Illy ~; Illy KOorl, deciIIon, _1l1lMIIAtIoft or the Cltr MIn-e-r or Iny ct)' bclIrd or COIMIIttaoo; or Iny 1dIon. declllon or lCCGI'I'Il\oII_n or any ct)' ","","...1 ~ 'n ...., 1NI1l".. In ZIlla MCtion, dullng die time period d dle entire lIolcirlon-mIIrIllIl ...- 0fI1UCh 1CUon, deelllOn or retOlMlel1ClltJGn thllE tot_Illy will be "-d 01' teYIeMd by 11M city _filion, Of I city ~ 01' _....... 1M WIn 1PIC1Ilcd,/, Indudu !hi princiPII_ .... .. lit'/' emplOl/" ....".,. In IobbvInl IcIMIes. .... -..... ~'".",."r loa ~ ......... ......... fa ____ ZOO4-.N:as. IJLl.Jk~ 1~ NAME OF LOB8'f'IST: (L..t) (M.I) f!1f:!~:;'~4hf.ey~;tr~~~ ~//Vd'a4 r:= An~~ 1tdfY/ 3Qj'- 861- fjj~~~ .?cd:.. R6/ -!'{t '/J /J1/tu1/k~J, i7A-V1"J (C~ '&JA,,)'/! Nel TEI..EPHONE NlII'IleR: FAX NUMIlSl.: EMAIl.: r. LOIIII\'JST RET.IJNI!D BY, /J;'~/ g"c,..~ d;bJ.er;Y.:JY+J teder ,;WL NAME OF PlUNClPAl/CUENT: J 6stx::> /Nl,CLo C~k KJh ik- /J/t'CH-1/ &c..$ 8USINESS NIlMl! AND AOORfSS (NuriIer Iftd SItNC) (CIty) ~30JA66/ - 981t ~-Bb/,J>KY/ 'll!l.ePHON! NUMBER: FAX NUMlEIt: (Optionll) ,Ii, 3.3/ y/ ($IMI) (ZIp CodlI) ,.-o//O-o?/be,,"~,I"t;W,~ &//JC<..JJf. /Y...I- EMAa: 111) fII............ . fI 1 .......... c.,.. r- . _1'Iwt ~ 2-4U (el] . NIIllIE OF CHIEf' 0f'flCEll, p~ orl.llEf8'1-aARV: R~oJd I~, ~4~ ~ ILLllERSONS HOI.DDfG. 0IllECl1. 'I' OR 1NOJAfC1\.Y. A W. ell Mlllll! ~ INTIlU!ST 1M $UOl CClU'OM11Of4. PAImlERSHIP OR'11WST: I II. W'I!~.....v -.e. /fJ1a-m ked. J/t4 /TJu,...f ~Jt'c.. .)-,'cP/) 1- lr) be lobbied co..crlbe In detail): IlL CI1Y MfNCJra/DlDIVIDUIC.S ~...~ ~ fIIlI"-" ... ~ T"''''' .,.,-nd.............A I ...~ r. . I~ JUL-28-2004 05:26 PM SHANE WArERSPORTS CENTER 3058618841 P.05 IV. D.........1tE 01' -- AND AMDUIfI'I 01 L08IIYISI' COMPI!NIATION (D~ WItl'I'tIa HOUItLY, FI.A TItATE 0It 01HIIl): A) L08msr DISCLOSlJRE: CItMI*-dJ AI(.;r. e...- . 8) PAlNClPAL'S DISClOSURE (Of' 1.088Y1ST lXM'ENSAllON): (~=.....:~ No /) c.- B ~ ==- dill(!l.........anftteDlllOl===-_~~ .......lIDIIl__. -I.-_ -~_=- PursuantIDOnI............sas. 1) ~~G.~ -1Id_S~~'::-;~~~i:~~s ~"CIl =~"'" FinlInrlI!! ItIIlbrm" !1_ ______ CW\~~~ ~ '~On Pnxa.nrn.nt 'ea~. Y.. ~ :-.:::;:.::.~~ ~~~-:..~? ~ ~ ._'-~Gr_III-- __.. It 2) ~"':1lC:--~~ ~;::.~==~~~~-'1.:'~~v:'s ClIm~" l"1'Inhtho-1III1~_On Ada ~ ~ i~, ~~:..~~==--...:. :"~-.;:..=.::"_~=~ 8I8NATUIU! UNDIR OATH: v.C9 v. ON oc:I08EIl 1" OF IACH YIAIt, UaI LOMVISr SMAU. -....rr 1'0 'nil CITY CUIU( A _ED STA1'IMIIIIT UIIDIa ouw. '-.- LOHYIIIIG IEXJIBIDl1URII. ... WIt&. ,. 'COllflllln1la. 1tICIIVID. "1MB cnv OF MIAMI 8bOI1'OIl THIi flN(l~ CALI...... VIM. A STATIM.". :::l:",,=""---:::~<-- ; 1'~4-- , SfGrt...~~1It J do SOIemnJv SWI8lIIr that aU tI b1e lbnIgoIng facts ani true and COfI'el:t and thllt I haw .... or am I'anIllIar WIth the pIOVtsblS contIIlned In Sec~ or the MIami Belch Oly CDde and all reportfng teqUl~. ~/ SlgnabJAiII tllObbvIst: ..-c '" ~;; _ S/gnatule tI PrlndpeVOlent: VI. L08IIYISI' JDBnJlIJcA11ION. MlNClPAL"81nPIQlTlON, D Produced 10 o PrOll.ICed IO Fclrm at Jde1UtIc:IIIIon ){ ~ known (LobIl)Mt) VII. BlGNA'RMI AND STAMP OF NOTAIM s_ or I'lortcla, Olluntv at M1aml-oecte sr. of 1'lorIdI, Countv ar I'taml-oede ~swcm to lII1<t subscribed ~~ Sworn and StaatbIld beft:n me _ - ~:::; 111'fL.. =~ ':"-"''' .'L of PU:lUc Nctay - Stale of.Boridlt :want oee.3L-.e ~ NotMy _ StIle at Ror1dI 1Io.............elLllIlIl/IH".lI ~.:'::~of... .. r.y .... .. ~co..~ iIlOF ~ t'i. Fom d Ide'llIftcaaon 11 P8'sanaIIy known (.....1ICIpIII) ~--y """-I ........... I'M: C ] Y. [ ] No Jlmool MCR .. rw... ..... Lobll,Ioc "-11*- I'oron "**"'-d .... -wled by: ........ O2IlD/04 F: lI. H\LOli8~1\U*n5T POIIM 04 "f!) / Uo I <N