Affidavit Americo Domenico
.
lQ
-
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerk(Cilci .miami-beach ,fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRlNCIPAL 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 CITY BOARD OR COMMITTEE; 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 CITY
COMMISSION, OR A CITY 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 ACTlVrnES 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 ~F WITHDRAWAl." ~
1) Lobbyist Name: M~,J")'/c ~~ ft?tlS~II'M ~ r ~J
Last ame FI st Name Middle Initial fJ<1Y719. tJ
Business Phone (~J) ~S" /4/'0 Message Phone ~J) 5~r It/I 0
Business Name and Address: ,Rv~q.lill )?~~)'IE <I *W::;Je:.. I! 'f. (lZvr1).
t/o/1 ~ I/ffc 2W /11. ~ Fr. '"3~/t./o
No. Street Suite City State Zip Code
Email A~dress...:....~J(HA ~ ~SN ~
2) (~ggciP~ by: ~U7 _c;.D .
If different from above
Street
Suite
City
State
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
beneficiary or interests.
3)
Subject Matter (Descrjbe i
,.7
. ,
.Detail): /)
a.~f
'5:' c-
4. '~Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: _/~. ./ '.
~. P-u..... I/Uo; :~,e, MILt.IAW ~
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
o The City Commission
a City Commission Subcommittee
o City Staff I ~ .
Il'" City Board or Committee fhs~/':- ~A17PN.
a Personnel
a Identify Others
6. State the extent of any business, financial, famili
individual identified in number (4) above: .
on . 2001
on , 2001
on 2001
on M1j e> : 2001
on ~. 2001
on . 2001
elation.ship which exist~ with any
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 contain in Sectio - 82 of e Miami Beach City Code as amended, an/~ all re/;?rting,
requirements. ..... A .1 ~
Signature of Lobbyist: a( 'tt&i1 .
I
o Personally known
o Produced 10
Identify
a Did take an oath, or
a Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of lIP 1 ,2001.
Registration:
FOR CLERK'S USE ONLY
[ ] REJECTED
DATE:
If rejected, state reason: //
Registration fee paid: (fffes [ ] No/'[ ] Not-for-Profit Organization 9--
[ ] Cash [ft'Check MCR # ;:; ~:::;
dt .2001 ENTERED BY: .~/-
DATA ENTRY DATE: