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Jose & Zunilda Pacheco \ . m - CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 citvclerklOlci. miami-beach.f1.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 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 FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION, OR A CITY BOARD OR COMMITTEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT, ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES 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: Bomfa Last Name Business Phone (305) 866 1014 Wesley First Name L. Middle Initial Message Phone (_) Business Name and Address: TELESCO ASSOCIATES INC. 260 No. 95th Street Street 203 Suite Surfside City Florida State 33154 Zip Code Email Address:ttelesco@the-beach.net 2) Principal Retained by: Jose & Zunilda Pacheco 1430 Michigan Ave. If different from above Street City Florida State Suite 33139 Zip Code Miami Beach (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): We are requesting a Certificate of Appropriateness to construct a two story, single-family residence on a vacant lot @ 1436 Michigan A venue ~ . . . 4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff) to be lobbied: The City of Miami Beach Planning Department, Historic Preservation Board 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 ~ City Board or Committee Historic Preservation Board o Personnel o Identify Others on on on on October 9th on on 2001 . 2001 . 2001 .2001 ,2001 2001 6. State the extent of any business, financial, familial, professional or other relationship which exists with any individual identified in number (4) above- None Whatsoever ON OCTOBER 1ST 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. {~(o/ Signature of Lobbyist: QlI Personally known o Produced 10 Identify JOSEPH MERLO , My Comm EIop. ~\a,1M No. cc 92&\99 1~_lI_l.o. 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 Eighth day of October ,2001. /t~or~~lerk bA-'...f'U U-, ,,~ If Notary, print, stamp or type as commissioned Registration: rACCEPTED If rejected, state reason: Registration fee paid: [ ] REJECTED FOR CLERK'S USE ONLY !,)j <3/(/1 { DATE: Yes [ ] No [ ] Not,for-Profil Organization .Cash [] Check MCR # - 2- DATA ENTRY DATE: tb.i ~ ,2001 ENTERED BY: