Affidavit
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CITY OF MIAMI BEACtI
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerk(IDci .miami-beach. fl. us
AFFIDAVIT
3)
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, ACTION OR
DEOSION OF ANY COMMISSIONER; ANY ACTION, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMmEE; OR ANY ACTION, DEOSION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN..,I\!q'( MANNER
IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING PROCESS ON SUCH ACTION,
DEOSION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMmEE. THE TERM SPEOFlCALL Y INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL. REGARDLESS OF WHETHER SUCH LOBBYING ACTlVITIES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT. ATTORNEY, OFFICER OR EMPLOYEE. EACH
PER,SON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO ALE A 'CERTIFlCATE OF WITHDRAWAL"
1) Lobbyist Name: Jvt/1J€76t.J8::r M. ~r:67T
Last Name Rrst Name Middle Initial
Business Phone M: ~78. 2()1~ Message Phone (_)
Business Address: 41,0 LI~LN !?OkD ~
M//flI1/ Ib~tf fJLe.et 86/Br Suite
City State Zip Code
Email Address:.S.h1/I1.jOhef(!..~/M/~j-I.lI5..l1 ,C4>14
2) Principal Retained by: ~~{I/~rrnJ~ ~p
21U 'fiWC~ d8 llUN bLVD, "~~n
If different from above Street Suite
GI\~ ~/..i..r h 3J/~4.(;211
City State Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
d~ 1\G1G.. . WIi Z
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Subject Matter (Describe in be~i1);.~ () _ ~~~ ~"\
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4. . Identify eachindividu"al (CommiSsioners, Board, Committee, Authority member or City staff)
to be lobbied:. . ~M.'(f/f/'N~r. C'Z )"'7f~ -1x/D
r~L-17nV Cnn/l1./m6 ',11!f'A (~ Jt;f!1f .m,
f;t~S~Pm/)~~ ~ /{1=4
5. The subject matter in number three (3) above is to be consider~ at the meeting of
(IdentifY-each entity or individual):
0 The City Commission ~ IJdr ~MI,J1iI on .2001
0 City Commission Subcommittee on .2001
0 City Staff on gll~ .2001
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0 City Board or Committee on .2001
0 Personnel on Ni5 .2001
0 Identify Others !"JIYL./v,7117V CJ?owIl1J1l1U.. 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: tIfi'J J.)aeJcJ Ju/TH- ..
~
/tfM If IJ. CntJJ'I-It 111NT ?a 1JfZ C)17 /)J. ~ IJ:rJjd"s
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 Oty Code as
amended, and all reporting requirements.
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Signature of Lobbyist:
o Personally known
IIVProduced ID H
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Identify
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.';'i :',JI
o 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 sub~d befo~e
This /?!!Ldayof ~~ .2001.
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t7 ~~li1&m'l\" ,RPlY erk. ......
. ~ ; My COl1lmiasion DllOO2020
\; 't# ~Vp'-- e_L.'"'1"_i:) 18, ;;91
If Notary, print, stamp or type as commission~c1
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Registration:
[ tCCffTrED
FOR CLERK'S USE ONLY
[ 1 REJECTED DATE:
~ J/;>/ (JI
If rejected, state reason:
Registration fee paid: es [ 1 No [l Not-for-Profit Organization
. [ lCash [ Check MCR# 4'?.:J<V7',/
DATA ENTRY DATE: , !) / / d / . 2001 ENTERED BY:
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