Affidavit
~
-
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvcl erk@lci.miami-beach.fI.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 CITY BOARD OR COMMffiEE; 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 COMMffiEE. 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 FILE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: ~ ) N.
Last Name First Name
Business Phone (~"Jlq 47'10 Message Phone L)
Business Name and Address: ..MIL-Ik'R (~ULT\~lll\\(.
?<o\O :(,MI.!L.. (..bJTr7lIL BulD ~Jo_ rsMl'AtJo ~-I+
No. Street Suite City
Email Address: .i? yv\ +r..alM i (G) De-I bo utk * Yl~t
2) Principal Retained by: n(~tDe Un.JOO -=lti:? I HSf.le(2 j..s.~
CRA\~
Middle Initial
"'PI..-
State
;3':3'oc:;.4
Zip Code
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.
Subject Matter (Describe in Detail): I
.f<r=;1v:;::e.J-rS /f)f'fb5e l-\AZLEWOt:O ~, "-Y~ J>+jD ~') 'fn
-1=f.;~ .\t;'LI'<to.l<? I::> kIO-r "c;/>rf;i AuO t2APu::>" A6 !<f:QUli12eO 10 (Kr'f' C17r.;;;6.
3)
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied:
11rrr N~
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
eM \-3 Ot%'IC9,J r:p.rc::Jlf3tJ ~
o The City Commission
o City Commission Subcommittee
o City Staff
o City Board or Committee
o Personnel
o Identify Others
.2001
,2001
,2001
W~~-: 2001
2001
,2001
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:
U()~
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 Sectio -482 of the . mi Bach City Code as amended, and all reporting
requirements. "
Signature of Lobbyist:
o Personally known
A Produced 10
j:" La e... t D A "Dn v.....~ /..--. <- <+-$'"
Identify
82-0
o Did take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This It ~ day of J u. \ ~ . 2001.
A~J~
Notary or Depllt'l C1er~
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration:
[ ~CEPTED
[ ] REJECTED
DATE:
1
II 0\
If rejected, state reason: ...
Registration fee paid: [--(Yes [ ] No [] Not-for-Profit Organization
[ ] Cash [v{the<-k MCR #
DATA ENTRY DATE:
.2001
ENTERED BY: