Affidavit - Gone Native, Inc.
JUL-31-2001 11:43
.
CITY MIAMI BCH CLERK DEPT
305 6737254 P.02
~
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvcl erk(Cilci. miami-beach. fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYEO OR RETAINED, WHETHER PAID OR NOT, BY A PRlNOPAL WHO SEEKS TO ENCOURAGE
THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR DEOSlON OF ANY COMMISSIONER; ANY
ACT!ON, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMmEEi OR ANY ACTION, DEOSION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURlNG THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING
PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABLY WIll BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A ClTY BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINOPAL p.s WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACT1VITIES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS p.s A
LOBBYIST IS REQUIRED TO FILE A 'CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: .i O,5€f>'^ IA. Gv ~j 11.
Last Name First Name
Business Phone (lfJ'1) l3 l.( t- - J ~? 1- Message Phone L.J
Business Name and Address: oS' h v t+J 4- e.owel'\ /.... t.- .p
()JXJ E. ~l1w<<~ g Iv'L d J,OOeJ Ff- tCiv'~rt"~ f:L-
No. Street Suite City State
Email Address: -djo Ids 4e. ,~\(~ ~~v.Hj-Ic:;-"". W VI",
2) Principal Retained by: fof'/~ NtI.-\-Ive ~ t.
,qUo 5vY\k~ \.w-bovrL {)~i-re.. I ~5
If different from above I' StrE!et
JVI'*"" ~..eCl.t~ ,L-
Oty State
Middle Initial
~JtjCJ
Zip Code
Suite
)?U<1
Zip Code
3)
(a) If a corporation, partnership, or trust, identifY and provide the address for the chief officer, partner,
beneflclary or interests,
SG~~tCl~ove.. - JJCl.V\c; Mc...\Cf"'t\ey .,Ilf'(l,
Subject Matter (Describe in Detail): f\1ndA ~cohJV\ J:;, friVl 'ovJ
{AV\~OV\i Vlt Jvtlld tfl\-r10vYL MO"lV'C(
h 1Q... __ I '{ __ <1 I
\.
JUL-31-2001 11:43
.
CITY MIAMI BCH CLERK nEPT
305 6737254
P.03
"
.4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: 1> I A-~p,\ ,. "5 g(.tl..... d.
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity 0
individual):
on
on
on
on -:r)), I
on '
on
.2001
,2001
: 2001
2001
,2001
,2001
a The City Commission
Q City Commission Subcommittee
o City Staff
Y:a City Board or Committee
Personnel
a Identify others
6. State the extent of any business, financial,
individual identified in number (4) above:
iral, professional or other relationship which exists with any
(\.e
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISnNG L08BYING 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 2-482Ji)]Jff the Mia i Beach Oty Code as amended, and all reporting
requirements. IA> >
Signature of Lobbyist: vYVI
la, rJnVl"v ~'(!I'\J-e #- Cy
Identify
CJ Personally known
~ Produced 10
}
Did take an oath, or
Did not take an oath
State of Florida, County of Miami-Dade
Sworn to~nd subscribed before me
This lll.ctayof ~ 2001.
(J~
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: [] ACCEPTED [] R.EJECTEO DATE:
If rejected, state reasoo:
Registration fee paId: ( ] Yes [ ] No [] Not-tor-Profit Organization
[ ] Cash [ ] Check MCR #
DATA ENTR.Y DATE:
2001
eNTEReo BY: