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Affidavit (02/09/2001) ~ CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 1700 Convention Con"', Drive MIlImI Beach, FL 33139 citvdf!rkanci Illiami-hp~r.h fI us AFFIDAVIT LOBBYIST MEANS ALL PERSONS EMPlOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINCIPAl WHO SEEKS TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR DECISION OF ANY COMMISSIONER; ANY ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMITTEE; OR ANY ACTION, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DECISION-MAKING PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABLY WILl BE HEARD OR REVIEWED BY THE CITY COMMISSION, OR A CITY BOARD OR COMMITTEE, THE TERM SPECIFICALLY INCLUDES TliE PRINCIPAL AS WELL AS ANY AGENT, ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAl, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT , ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A LOBBYIST IS REQU~D TO FILE A 'CERTIFICATE OF WITHDRAWAL: 1) Lobbyist Name: C /rtLnJ CH-th.J.o IJ. Last Name First Ncrne Middle Initial 'Business Phone (.5oS) "'),-/ .O"ll/"l Message Phone (sOS-) ("l!.P1./47 Business Address: -t.s7 'I / S-Jre~ f M/ ' A A I . /J I No. titreet /v/,qmt oe 1U:/" t:!:::. City State Email Address:ai.fl.SG.lr..n(Ja()/.CA7n.1 2) Principal Retained by: HaI....:"a / Oulrloort- 14~;://a g37S' l. J.,.d f'Aeef If different from above l-o"'L!. &a ~j, , City .5'31 fOuite Zip Code Street w- StA..,Ie,J Suite 908'03 Zip Code State (a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner, beneficiary or interests. Je.l-f :Ie /I):; hS - 4. Identify each indivij:lual (Co~missioners, Board, Committee, Authority member or City staff) to be lobbied: f}11 CO....m',j"$,..nf'r.( rMUfoy tt~cI S-/...ff ttJ nf'((>J'..r~Ar . Mt1iiAt;o.!IWi<> ~ 5. The subject matter in number tf1ree (3) <Dove is to be considered at tf1e meeting of (Identify each entity or individual): N a t- 'it + ~<M>d,1/JP(J. Q The City Commission on .2000 Q City Commission Subcommittee on ,2000 [J City Staff on ,2000 [J Ci ty Bocrd or Com mi ttee on ,2000 [J Personnel on ,2000 Q Identify Others on .2000 6. State the extent of any business, financial, fanlilial, professional or otf1er relationship which exists with any i':ldividual identified in number (4) abOVej My ~,,,..t::2 C;fr,,, f::/n{)M;(, I ,,~s().f'~ h4.~ o...c-~d. ~.<: I n.rv..rA.-1\cA tl f~-t... ,.,-n I n.su _ sold. +v -fl-e, ~. ON OC1'OBER 1 Sf OF EACH YEAR. EACH LOBBYIST SHAll. SUBMlTTO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, UmNG LOBBYING EXPENDnuRES IN THE aTYOF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. I do solemnly swear that all of the foregoing facts are true and correct and tf1at I have read or am familiar with the provisions contained in Section 2-482 of tf1e Miami Beach City Code as amended, and all reporting requirements. . (1 ~f1 (JtJ:j/LU'- Signature of Lobbyist: .,( Personally known a Produced ID / Did take an oath, or a Did not take an oath Identify State of Florida, County of Miami-Dade Sworn to and subscribed before me This 71 sf" day of :JAI-I\lI\K:L(. 2001. Q Notary or Deputy Clerk (1rl'~ ~. OtJlYlA-S If Notary, print, stamp or type as commissioned FOR USE ONLY ] REJECTED DATE: r?/r;! tJ I 2.001 Cllrln Financial .Inaurance, Inc. o """ '., ':p \ a' Insurance, Pensions & Investments ...-.1.:: CHARLES A. CITRIN Pr..ldent \~_. . fT-; ?> ,- ~ rJ: ..;la- g s:;', -n n r'f'\ Februmy 2, 2001 City of Miami Beach City Hall AUn: Robert Parcher, City CIeri< 1700 Convention Center Drive Miami Beach. FL 33139 RE: CHARLES A. CITRIN LOBBYIST REGISlRATION Subject Matter: Pay Telephone Sites (First Amedcan Telecom) Principal: National Outdoor Media Dear Mr. Parcher: Enclosed please find Affidavit dated Janumy 31, 2001 containing my original signature which has been duly notarized as well as my check payable to the City of Miami Beach in the sum of $25,00 for the registration fee, Thank you, M/ CHARLES A CITRIN CAC:cmd CITYM.iamiBeach.Lobbyistl 757 41st Street, Miami Beach, FL 33140 Tel: 305-674-0447 . Fax: 305-674-4B43 Securities ollered through Dempsey Financial Network, Inc, Member NASO, SIPC P \1l () (\1 - ,.::: rn '0 <J' ~