Affidavit
~
....
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk(illci.miami-beach.fl. US
AFFIDAVIT
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, RESOLlJTlON, 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 FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMITTEE. THE TERM SPECIFICALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVIllES 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 'CERTIFlCATE OF WITHDRAWAL."
1) Lobbyist Name: OIl..~Go')fJv ,'( (.,o(2./~rV
Last Name First Name Middle Initial
Business Phone ~ .5 2 '-I - '" q q '1 Message Prone ~ ? q \ - AI/Ii!!J? .5 S'1. t.)
Business Name and Address: Fr r'sr AM l:y,'ulAi TFI fee 0 fY) CD"')) ,{ h,(+ AM~Vmof'l A/vfrf,JitfJ Corp.
ISn Nc L{ live M+ C.<J~d&ydAIG FL. 3330L(
No. Street Suite City State Zip Code
EmailAddress: ftJf-Covp ~ VSJ.l. CoM
2) Principal Retained by: ,-1~ ~ ~!h K
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 (Dl!lIaibe in Detail):
o
UJ
"-
,-
J:Uh~'1I=IH{\M4''l\iNdAholJs. AMPNO FX,;\+iN, OrdilJ~NCr; f(J
- C
..:.. ..:::}
INcl~tll: AJ,vuh,iiJ~,
c.): ~"f)
;",",.
,
\'
(
L.
f::':'::':
-,
'.~-
""
o
, .
4. 1de.t1:1ft each Individual (Commlrslllfl8l S, BoercI, Commltt.a... Authortly membeI or aty stall')
to be 1oIIbIed:
A II Co m"" ".\"i fA A1P(( .
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual) :
eg. The City Commission
.1IiI. City Commission Subcommittee
CI City Staff
CI City Board or Committee
CI Personnel
CI Identify Others
.2001
.2001
.2001
.2001
.2001
.2001
on JUNE 6:
on rf'-NOifIJb
on
on
on
on
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above: tJ 6 ~112 .
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYISf SHALL SUBMnTO THE QTY CLERK A SIGNED
STATEMENT UNDER OATH, LIS11NG LOBBYING EXPENDITURES IN THE QTY OF MIAMI BEAat
FOR THE PRECEDING CALENDAR YEAR.
I do solemnly !>Wear 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 City Code as amended, and all reporting
requirements. . L A .M 11. ~
Signature of Lobbyist: !J1'} vJ,-",,! ~
~ Personally known
CI Produced ID
Identify
IJ Did take an oath, or
IJ Did oot: take an oath
State of Florida, County of Miami-Dade
Sworn 19.a1)l:l subscri~
This ~ of 2001.
~~)
ry o~~~one
*.*MyCOmmi_CCI"lJoI3
'\;.....:.1 ".1r41 r.....1'f21. 200~
If NoIary, print, stamp or type as commissioned
FOR a.ERK'S USE ONLY
RegistratiOn: [] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit Organization
[ ] Cash [ ] Check MCR #
DATA ENTRY DATE:
. 2001 ENTERED BY: