Builders Assn South Fla
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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. fl. 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 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 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: r&Ji2-{'--C)jV ~
Last Name Fi~t l':Iamei<- owi
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Business Phone (~) 931 ;...J ""''' . Message Phone (_) . /1 ~. ~\
Business Name and Address: BWltdJkP ~;>J ~lJilL n /'r(!){JI-.J-~}j /
I S ~ 1;"" tJ w 7; ~ ~.icLqv] /Io-mo 1'2- ~J
No. Street Suite City State Zip Code
Email Address: ~1 Vitn\ @~Q/VLfr:
2) Principal Retained by: .so /('rJi J Q.J) (ff ~,
Middle Initial
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.
3) Subject Matter (Describe in Detail):
(OJJ/td?mllffrU m J)p~ or-~~~
~)
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied:
COhn 01. ,!W) ~) c.;1i~ s~
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 9ty Staff
cV""City Board or Committee
o Personnel
o Identify Others
on I () ~ 11 . 2001
on , 2001
on . 2001
on ~ 2001
on , 2001
on , 2001
6. State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above: -f.-\ ~
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.
Signature of Lobbyist: ~ r iJl.1rvJ
o jle'rsonally knowl1yJ ( .--:> 5 " / .--- S- c> (
ty'" Produced ID f; l(> ~ - 1(0 'f -_\ I - (] ,\ - 0
~ Identify
-0- Did take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
S~or'?:Ji9 ~ld sUbscribWh~
This ~day of 001.
(
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY ~. J
Registration: [] ACCEPTED [] REJECTED DATE: J 0 !.i2 I
I
If rejected, state reason: /
Registration fee paid: [ ] Yes [ ] No [VNot-for-profit Organization
[ ] Cash [ ] CheCK MCR #
DATA ENTRY DATE:
.2001
ENTERED BY: