Affidavit (Walgreen Co.)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Cel,ter Drive
Miami Beach, Fl33139
citycl~rk@ci.miami-I >each.f1.us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACl10N OR
DEOSION OF ANY COMMiSSIONER; ANY ACl10N, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMffiEE; OR ANY ACl10N, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECl10N, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING PROCESS ON SUCH ACl10N,
DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMffiEE. THE TERM SPECIFICALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACl1VITIES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL.
Lobbyist Name: Larkin
Last Name
Business Phone Qa..s.) 377 - 6 2 31
1)
.Michael
Fir;.t :lJame
W.
Middle Initial
r.essage Phone <->
Business Address: 200
S. Biscayne Boulevard
No. Street
Florida
State
33131
Zip Code
850
Suite
Miami
City
Email Address:
2) Principal Retained by:
Walgreen Company
If different from above
Deerfield
City
200 Wilmont Road ri';"
Street
Illinois
St~te
MS 2252
Suite
60015 . ,
Zip Code
(a) . If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
3)
Subject Matter (Describe in Detail):
Design Review Board Approval
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: Design Review Board <'cA- fl'bhr ~LJJfj; Ci+-t sl$ )
5. 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 on .2000
a City Commission Subcommittee on ,2000
a City Staff on ,2000
Xl City Board or Committee Desiqn Review Board on March 20 ,2000
-. Personnel ,2000
a on
a Identify Others on ,2000"
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, USTING A 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. A --lA, I A / ..,
Signature of Lobbyist: ~ L,...-/" V
Xo Personally known
Produced 10
.,.
'..'
. "
Identify
.-, .
( .
o Did take an oath, or
)( Did not take an oath
State of Florida, County of Miami-Dade
Sworn tp ~~subscribed before me @/
This -L! day of ~ 2004.
.....".:"... LISA C. BROOKS
r!':b.~:, MY COMMISSION # CC 856829
~~k! EXPIRES: July 20, 2003
"l,t.iif..~~ Bonded Thru Notary Public Underwriters
~v~.
Notary or Deputy Clerk'" .., .
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: C)t ACCEPTED [] REJECTED
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit OrgaJliz.gtlql) t1 17
[ ] Cash [ Check r 'r:R # ri:.2 '1 0 -f ~
DATE:
I IIS/() /
/ /
.! :,.1
DATA ENTRY DATE:
2000
ENTERED BY: