Affidavit (750 Collins Ave.)
..,
CITY OF MIlli4I BEACH
OFFICE OF THE CITY CLERK
LOBBYIST REGISTRATION
AFFIDAVIT
lId
-
LOBBYIST SPECIFICALLY INCLUDES PRINCIPAL AS ImLL AS ANY AGENT,
OFFICER OR EMPLOYEE OF A PRINCIPAL. EACH PERSON WHO WITHDRAWS
AS A LOBllYIST IS REQUIHED TO FILE A "CERTIFICATE OF
WITHDRAWAL."
(1)
Lobbyist Name Hesei'l; Harold
LAST NAME, FIRST NAME
Business phone (lQL) 534-4757
MI.
Business Address 407. Lincoln Road, Penthouse S.E. Zip
Miami Beach, Flo~ida
Principal Retained By: Qlli "kil;i lv""r
33139
(2)
Principal's Add:;:ess 750 Collins Avenue. Miami Beach. FlZip 33139
(IF DfFFERENT fROM ^DOVE)
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!)
A Certificate of Appropriatenes for Desiqn.
. .
(4) Identify each individual (Commissioners, Board, Committee, Authority
member, or City staff) to be lobbied.
D~~iqn Rpvipw Rn~rn ~nn ~r~TT
(5)
The subject matter in number (3) above is to be considered at the
meeting of: (Identify each entity or individual)
o The City Commission
o City Commission Subcommittee
o City Staff
b City Board or Committee
o Personnel
o Identify Others
,19_
,19_
,19_
19_
, 19_
19_
on
on
on
on
on
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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.
tl S?Ve
-~ - .
ON JULY 1 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK, A
SIGNED STATEMENT UNDER OATH, LISTING ALL LOBBYING EXPENDITURES IN THE
GITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foragoing facts arc true and correct
and that I have read or am familiar with the provisions contained in
Section 2-1,6 of the Miami Beach City, Co ,as amended lInd all reporting
requirements.
Signature of Lobbyist:
~rsOnallY kno~~
o Produced ID
(WENT! FY)
o Did take an oath, or
o Did not take an oath
State of Florida, County of Dade
Sworn to and subscribed before me
this JK day of ~C-k:Jlz.ln61-l1.c9CPI
~ LCL CO IV'(:;
Notary
LAURA CANO
, My Comm Elcp, 1113004
~1~(f~I!S ommissioncd
No
******************************************************************************
Registration:
. fOR CLERK 'S USE ONLY
o REJECTED
....;.:.,.
DATE '3 -) -() I
If rejected,
f::a::i::as:c /0 No~
o Cash ~eck 0
Not for Profit Drganization
~~~u:~~t~ ~c:tu"t;C'lhed
Registration
DATA ENTRY DATE
19
ENTERED BY