Affidavit
. .
to
.,..
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 eorwenuon CentEr DrIve
Miami Beach, R. 33139
~lerk<lllcl.miami-beach.fl.us
AFFIDAVIT
lOBBYIST MEANS AU PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINQPAl WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIACATION OF ANY ORDINANCE, RESOLUTION, ACT10N OR DEaSION OF AK'f COMMISSIONER; ANY
AcrION, DEaSION, RECOMMENDATION OF ANY CfTY BOARD OR COMMmEE; OR ANY AcrION, DECISION OR RECOMMENDATION
OF AK'f PERSONNEL DEANED IN AIf'( MANNER IN THIS SEcrION, DURING THE TIME PERIOD OF THE ENTIRE DEaSION-MAKING
PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABl Y Will BE HEARD OR REVIEWED BY THE CfTY
COMMISSION, OR A CITY BOARD OR COMMITTEE. THE TERM SPB:IACAUY INCLUDES THE PRINQPAl AS WEll AS AIf'( AGENT,
ATTORNEY, OFACER OR EMPLOYEE OF A PRINCIPAL, REGARDlESS OF WHETHER SUCH lOBBYING ACTlVlTIES FAU WITHIN THE
NORMAL SCOPE OF EMPlOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPlOYEE. EACH PERSON WHO WITHDRAWS AS A
lOBBYIST IS REQUIRED TO ALft "CE~ACATE OF WITHDRAWAL'
1) Lobbyist Name: ~t(L. Per~ A
Last Name Arst: me Middle Initial
BusIness Phone (3D-r) Bs- - 'Z L::!.J Message Phone ~ '2-' ~ - t C> V{
Buslness Name and Address: .~ OOL,chev BroKIJfs Y!/'l-/I'!;I3"""h
1!2.i:!.Lt$ 30 d- ~t~ (--",.." F<--
No. 9reet n.. Suire City Slate
EmalIAddress: VOV~(O.5\.{ (0) G:jo I. co"')
L.L.-6
311 ))0
Zip Code
2) Principal Retained by:
If different from above
Street
Suire
City State Zip Code
(a) If a corporatlon, partnership, or trust:, lcIentify and provide the address for the dllef olIlcer, partner,
beneflctary or Intel ests. r.J 2
'l(2~~ t '30f't (C1f'J- ~'f\(.vr" I r"-' v3 (1 0
3)
Subject Matter (~~ibe ~~:
~l ~~ N1. 4rll ^ t,eS{i( 0 '"'
4. Identify each Individual (Commissioners, Board, Committee, Authority memberorCllystatr)
to be lobbied: jJ\(lor c:I"HI"" I.f- d/YIf,,':J~" ~'6 ~
r .~{,
5. The subject matter In number three (3) above is to be considered at the meeting fA (Identify each entity or
IndMdual):
.2001
.2001
.2001
.2001
.2001
.2001
\
6. State the extent fA any business, financial, familial, professional or other relationship whldl ~ With any
indMdual identified in number (4) above:
o The City CommIssion
o City Commission 5ubc:omrnitlEe
o City Staff
o City Board or ComrnJttee
o Personnel
o Identify Others
on
on
on
on
on
on
ON OCTOBER 1ST OF EACH YEAR, EAOI LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
SfATEMENT UNDER OATH, LlSrING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH
FOR THE PRECEDING CALENDAR YEAR.
I do soIermly swear that all fA the foregoing fads are true and correct and that I have read or am familiar
wittI the provisions contained in Section 2-482 fA the Miami Beach City Code as amended, and aU repol1ing
requirements.
SIgnature fA l.OObvisl::
~I~YLDL5 ~D~'~~ l-b9- 3~2-J
Identify
o Old take an oath, or
o Old not take an oath
State fA Florida, COUnty fA Miaml-Dade
~~~2001. <[,1J~~""
If Ndary, print, slamp or type as COI'lIl1IssIoned
fOR CLERK'S USE ONLY
ReglslTatlon: [J ACCEPTED [J REJECTED DATE:
If rejeCted, state reason:
Reg_on fee paid: [ J Yes [ J No [J Not-for-Proftt OrganIzation
[ J Cash [ J Oleck MCR #
DATA ENTRY DATE:
. 2001 ENTERED BY: