Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL ,~3139
citvclerKlOlci. nijalni~beach. fl. us
AFFIDAVIT
2)
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, DEOSION, 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 FORESEEABLY 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."
Lobbyist Name: ~2A#r~' #1tZtt'os . /f
.1.a Name ' , " First Name Middle Initial
Business Phone '~ gJ} -- '366:; Message Phone L) ~f~ ~~'1!5,413.
Business Address: //71 ,,L;f#e: an~ /ZCJ
~ ~0:/5' Stree~, 7-j~~
ity state Zip Code
Email Address:..~~~c..a.1t.JL ' ~
Pri'd~~~~~4~~~$
~fferent from above Street Suite
~6~ r=L ?7/~4-
Oty , State Zip Code
1)
3)
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
__V5~~_#~
Subject Matter (DeSCrlbeinDetail?: __ ":e.~C;; 'y, a:t-&f
. ' ,
4. Identify each individual (Commissioners, Board, Committee, Authority member or Oty staff)
to be lobbied: ~~~~~~~'S -I ~ .
, . . ., p' " ",'
5. The subject matter in number three (3) above is to be con!lidered at the meeting of
(Identify each entity or individual):
IJ The City Commission 78b
~ 2:~ ~~~mission SUbcommitte~~~
IJ City Board or Committee I _ _ _
o Personnel O~/~
o Identify Others 1__ _
.2001
.2001
.2001
,2001
,2001
.2001
on
on
on
on
on
on
6. State the extent of any business, financial, familial, professional Qr other relationship which
exists with any individual identified in number (4) above:
ON OCTOBER 1 Sf 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 ~Iemnly swear that all of the foregoing facts are true, and'corr~ ~d that I have read or
am famifiarwith the provisions contained in ction 2-4 the Miami Beach City Code as
amended( and all reporting requirements: '
Slg~ture,of Lobbyist:
V Personally known
o Produced ID
m o.r XuJ
IdentifY'
~l<ej
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o ~id ,take an oath, or
IJ Did not take an oath
~YP:\,OENAZEaHI!S. '
1& COMM,ISSIOt'i., C,C 706503,
~ EllPIRf$JAN5,2002
._ U :."'
~- ATIANTlC 8ON1),::g CO.. IN<:,
_~ (IA k{,e.\
Not r Deputy Clerk,' .
p or typ~ as comm,~onecl
State of Florida, County of Miami-Dade
Sworn to ind SUb~Or~)l'le
This //'1/7 day of ~.J.{&7 . 2001.
Registration:
fOR CLERK S USE ONLY
"4
[ ] RElECrED
DATE:
If rejected, state reason: ./'"
Registrationfeepaid: [f'(es []No~'iNot-fQr-ProfitOrganizatiQn, /1:" ',:-
.' [ ] Cash [frOleck MCR # . --:; -'l -51-/'::L \0 ' ::",; '.J
DATA ENTRY DATE: ,~ j /5" , 2001ENT~RED BY:~~ h,A'H.-
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