Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerk(Cilci .miami-beach, fI.us
AFFIDAVIT ,"
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAlO OR NOT, BY A PRINOPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, AmON OR DEOSION OF ANY COMMISSIONER; ANY
AmON, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMffiEE; OR ANY AmON, DECISION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SEmON, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING
PROCESS ON SUCH AmON, DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMffiEE. 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 OF WITHDRAWAL."
1)
Lobbyist Name: C1C~
Last Name
II~
First Name
B,
Middle Initial
Business Phone ~ ~4S- ~ Message Phone L)
Business Name and Address: USA ~" Co\. c @ YO, '""2 A .
- " ,
\ CSD A U!t\Mp..,f' A Ctf2..c...lk -1t '(2....1-0 ~ 6A~ :t==1 ai"P~ LA
No. Street Suite City State
Email Address:
2) Principal Retained by: .:pA12':j4YL t=t>)(
"'Z~ \<'oYAL.:?AU--"\ ~_.
If different from above Street
col~
Zip Code
Suite
!Yt1/4f"Y)\ ~AGt-\
City
\=\..08. t),.A.,
State
.50\~
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):
~-=Tb:A"LIL. va.-ria.nce.--IrJyP{fY)I-t ?Sl N,"iIIY1(Y)In:) ~I"
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied:
CdL-j cl J--ltGI--U' ~Q{'y. ~ V'("~~ A~rr+-
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
o City Commission Subcommittee
o City Staff
0"' City Board or Committee E:li!a
o Personnel
o Identify Others
.2001
.2001
.2001
,2001
,2001
.2001
on
on
on
"2'onv.q) ecl/,L\qJ.I~ on .:JlJL':j to
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: NONe.
ON OCTOBER 1 Sf" 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 contained in Section 2-482 of the Miami Beach 'City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
o . Personally known
~ Produced ID fJLdj
:Ud ~ !?~L#)
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dJMu .eo-eXMJD
(! 01.00 - 5'"';;d~0 ~ - 7Gb -0
Identify
o Did take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and sUbscribed~'1 m,e
This I..!f, day of 2001.
/,:y ~t\. Liliam R Hatfield
, .,~.: My Comt'nissionOOOO2D20
\;(Jp'f'.;,.f Expires February 18, 2005
&~-IA'~~~
Notary or Deputy rk
~J,~d. ~~-J;
If Notary, print, stamp or type a commissioned
Registration:
[~CCEPTED
[ 1 REJECTED
FOR CLERK'S USE ONLY
?J~ /0/
DATE:
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If rejected, state reason:
Registration fee paid: [ 1 Yes [ 1 No [l Not-for-Proflt OrganizaW2:/ ~7
[ lCash [ lCheck ~ .~ 30'
DATA ENTRY DATE: ~ 2001 ENTERED BY: