Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvcl erklOlci. m ia m i-beach. fl. us
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AFFIDAVIT
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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 PER!OD 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: ~ IN. 1Vc.t::Pl2
Last Name First Name Middle Initial
Business Phone ~ ~"2.JIl
Business Address: K O. il ~ \ t>Sl>
No Street
(J!7)aJA,Ji r. t'l../).M. ~ }:;:
City State
Email Address: uJ1Ik1l.U>!J,hh./& WM~' UII4 "
2) Principal Retained by: ~J"AJ1 PLW/
fl3il tJ. ~ fUJAt:>
If different from above
fVl/~1 RJ~..I:f
City .
Message Phone (:lJfJ-1SV~d;J (" ~ )
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Suite
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Zip Code
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Street
Suite
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State
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Zip CodE!,. \.s~
(a) If a corporatiEln;partnership,' or"trust,ideritify and provide the address for the chief
officer, partner, benefidaryerinterests.
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3) Subject Matter (Describe in Detail): Pil IS- AItJ. ").)~ - ~IJ tJ. BAy It44/)
ftfPU(AtJJd.J FM.. ZZJAhN' II'MiltUu;:
4. Identify each individual (Commissioners, Board, Committee, Authority member or Oty staff)
to be lobbied: i1IJAt2.0 N: At{J7t1rm l!Pl
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
0 The City Commission on .2001
0 City Commission Subcommittee on .2001
0 City Staff on ,2001
JA City Board or Committee on IiJljttql ).. .2001
0 Personnel on ,2001
0 Identify Others on .2001
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above: NtJAl~
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIG!Il~D.~AT~MENT UNDER OATH~ USTING LOBBYING EXPENDITURES IN
THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear thatall of the foregoing facts are true and cOrract and that'I'have read or
am familiar'with the provisions contained in Section 2-482.o!.the Miami Beach City Code as
amended, and all reporting requirements. I .' . . , . . . "
Signature of LQbbylst -iV. -2u ~ \ ~:' ~j ,
a Personally known ", .. ,', , .'
_ Produced ID fi.A. oa/~ (At:. Ii 4"/),6 ..!iJ1.'~'fJ'" tI")i/'" ,.'.'., I
Identify , "
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'A Did take an oath, or
o Did not take an oath
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State of Florida, County of Miami-Dade
Sworn to and SUbSCrib~ me
This ~t\L- day of , 2001.
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~18'1!.. 1 or Deputy Clerk
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If Notary, print, stamp or type as commissioned
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FOR CLERK'S USE ONLY" '. "
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Registration: ~ ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid:J.'1 Yes [ ] No [] Not-for-Profit Organization
[]Cash []Check MCR#:, .,', ' : : ,
DATA ENTRY DATE:
.2001
ENTERED BY: