Affidavit (A Group Inc.)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerklOlci. m ia mi-beach. fl. 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 OTY BOARD OR
COMMmEE; 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 FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE OTY COMMISSION,
OR A OTY BOARD OR COMMmEE, THE TERM SPECIFICALLY INCLUDES THE 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 REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: ~~ ~ It-
Last Nam First Name Middle Initial
Business Phone J12[0 S71-Ctor::J.? Message Phone L)
Business Address: }Z '21 BI2L~ /fJe,..,
~ No. 'r'"( Street 32J/ sUle
, City State Zip CO~
Email Address: 1>0l.J')~ L r9 GQ.:T ~, cow...J\
Principal Retained by: fj- j; G:, ( () II ~ N c...-
S-tJO I .s w 74 tV\. d-- <;'.1< La.. 10 ?
If different from above Street
M t J'\vvt.A
City
2)
r::1
State
Suite
"3 ~I s>
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
Pr{ &.nlt<=-, ~~ f'rs ~
~ Q ~
4, Identify each individual (Commissioners, Board, C;ommittee, Authority member or City ~!J1f1
to be lobbied: c... '+-'A I"n,Al1oVU<"S.u}Jl/', :purC-i-t.r~..u-y Spas:Jr
\ /
e r ~ 1 )Jrt;ffi I 1\1-;
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
on M rAr ul/'-.... 2001
on , 2001
on , 2001
on , 2001
on . 2001
on , 2001
o The City Commission
o City Commission Subcommittee
o City Staff
o City Board or Committee
o Personnel
o Identify Others
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above:
t\lo~jL
, v. v
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OATH, USTING 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, ......) ;)
Signature of Lobbyist: ~
o Personally knorq1 I f rl r ::\
~ced ID rL-f)). ,J.).J-~2,- Y2.J - 'fOr)J7 </-0
~ Identify
,liOl"Oid take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Sworn)jO arp sUbscri~
This ~day of 001.
CO~~~
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY ~ )
Registration: ~PTED [] REJECTED DATE' '2--- t\ I
I '
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No .---f-1 Not-for-Pt(efjt.ArQa~i,zatjQn l
[ ] Cash []1:heck MCR # ~l)",,\ D
DATA ENTRY DATE:
,2001
ENTERED BY: