Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerklCilci. mi am i-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 CTIY 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 l;HAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CTIY
COMMISSION, OR A CTIY 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 ACTIvmES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A
LOBBYIST IS REQUIRED TO FIL~. "CERTIFd.E OF WITHDRAWA'il 0 'L
1) Lobbyist Name: G r70 It~ <!t.A1 It' 0Tr S -
Last Name First Name Middle Initial
Business Phone~ & /'3> ()f7 7 Message Phone L)
Business Namj and Address: _
( ?;ol 4-1 <;
.
+-, HJu- v Pi
Street Suite City State Zip Code
Em,UAdd~, WB~ ea-rft,/rhl(, 1':01<1 f
2) Principal Retained by: b()t-t-O -II, (9 y//,(/ ~ ~_J~f3'/''J V~
"33/7h
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 (Describe in Detail): fe-It 11 J:7 F~ c/ ;;n--e j
4. Identify each individual (Commissione~. Board, Committee, Authority member or City staff)
to be lobbied: ~' or ~~ tfJJt/e. /"
(
S. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
./
ct---f~ City Commission
rd,..-<Ity Commission Subcommittee
~jty Staff
~i!y,Board or Committee
~rsonnel
o Identify Others
.2001
,2001
,2001
,2001
,2001
.2001
on
on
on
on
on
on
6. State the extent of any business, financial, familial, profe_.1 or other relationship which exists with any
individual identified in number (4) above: rei
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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.
Signature of Lobbyist:
true and correct and that I have read or am familiar
lami Beach City Code as amended, and all reporting
I do solemnly swear that all of
with the provisions contained'
requirements.
.0 J;ersonally known A3sr- ~,.- t1 '1 f') - ~ Gj -3 II .
Ig/Produked 10 '-J I '0 If'
Identify
o Did t!lke an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Swornl t? 1?f1~ sUbscribrrf~ m,e
This~dayof 2001. c..O~ ~ ~
'()- r ;;;;:;br Deputy 'Clerk
If Notary, print, stamp pr type as commissioned
Registration:
~~CEPTED
FOR CLERK'S USE ONLY (
[ ] REJECTED DATE: t::!r~ 6 I
If rejected, state reason'
Registration fee paid: [ es [ ] No [] Not-for-Profit Organization
[ I?~ ] Check~ MCR #
DATA ENTRY DATE: 5{6 (t) I . 2001 ENTERED BY: ~