Neisen O. Kasdin - Akerman LLP t\/\
I AM I BEic H
City of Miami Beach
1700 Convention Center Drive 2015 OCT 27 Ph 27
Miami Beach, Florida 33139
www.miamibeachfl.gov C 'r` +_ '_-::_ - OFFICE
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: 1eAc-e \ 0, 110S-06
Business Name: 41Ci"ñ4'Y\ LIT
Address: SE 3d AWAAje-i 01 Irt I l r (YuAyvli �1 i
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Office Telephone Number: 98/ C
Cellular Telephone Number:
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Email Address: I KA SC. hacCI ene çfr(,'y41. ccvll
If more than one lobbyist,please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: 407° (06
Amount paid: fie° Date paid: Cc L1 I
Processed by: CCU - 1�— Date: t D
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx
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City of Miami Beach-Florida
Finance Department
1 City Hall
1530013-1 10/27/2015 BR1 T113
Tue Oct27,2015 03:27PM Trans#2-2
2 $500.00 MCRCLERK - MCR-City Clerk
* MCR#: 408068
1 ITEM(S): TOTAL: 00
Check (17478) P AID $500
Have a nice day!
Miscellaneous Cash Receipt ,_ 0 i_;„.7 42015 o ¢t 1 1 -
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