Affidavit (Leah's House)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention C~nter Drive
Miami Beach, FL 33139
citvclerk@)ci.miami-beach.fl.us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODlACATION OF ANY ORDINANCE, RESOLUTION, ACl10N OR
DEOSION OF ANY COMMISSIONER; ANY ACl10N, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMmEE; OR ANY ACl10N, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEAN ED IN ANY MANNER
IN THIS SECl10N, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKlNG PROCESS ON SUCH ACl10N,
DEOSION OR RECOMMENDATION THAT FORESEEABLY WIll BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMM!lTEE. THE TERM SPECIFICAllY INCLUDES THE PRINCIPAL AS WEll AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, RE('ARDLESS OF WHETHER SUCH LOBBYING ACTlVmES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFACER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO ALE A "CERTIFICATE OF WITHDRAWAl."
1) Lobbyist Name: Bercaw Jeffrey
Last Name First Name Middle Initial
Business Phone Uo.5) 177-1\7.20
Message Phone (_)
Business Address:
200 S. Biscayne Boulevard
No. Street
Florida
Miami
City
Email Address:
2) Principal Retained by:
State
33131
Zip Code
850
Suite
City
420 Lincoln Road
Street
Florida
State
Suite 240
Suite
33139
Zip Code
Leah's House. Inc.
If different from above
Miami Beach
(a) If a corporation, partnership, ortrust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
3) Subject Matter (Describe in Detail): Variance to permit the sale of beer
and wine at the House Restaurant
4. Identify each individual(Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: Board of Adjustment(w4 Iv"'!.<.- ~:"d) ; c... J; S~
S. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
a The City Commission
a City Commission Subcommittee
a City Staff
III City Board or Committee Board of Adiustment
a Personnel
a Identify Others
.2000
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6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above:
ON JULY 1sT OF EACH YEAR, EACH LOBBYST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USTlNG A LOBBYING EXPENDITURES IN THE
CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
Signature of Lobbyist:
>( Personally known
a Produced 10
e and correct and that I have read or
2 of the Mi mi Beach City Code as
Identify
Q Did take an oath, or
)( Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribed before me ~
This ~day of 1 'U\AAIA~ 200~.
'~',
~..,.. USAC BROOKS -:~,
t:~~ MYCOMMISS'IONtCC856829 II
~ '... :! EXPIRES: Ju~ 20, 2003 I
.Rt~ Bonded Thn.I NQlary Public Underwril&rs
a.~loi'~
v Notary or Deputy Clerk
If Notary, print, stamp or type as commissioned
FOR CLERK'" USE ONLY
1/(0/0/
Registration: [ ')it ACCEPTED
[ ] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit ~~t)9n,.A 'I
[] sh 'fJ Check MeR # -,
DATA ENTRY DATE: 1 I () ) 2000 ENTERED BY: