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W. Tucker Gibbs - Al Berg City Of Miami Beach Lobbyist Fee Expenditure and Compensation Form City Code Section 2-485 Expenditure report for period of:1/1/2015 through 12/31/2015 :r , A statement shall be filed even if there have been no expenditures or compensation during the reporting period. This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office, 1700 Convention Center Drive, Miami Beach, FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due date.If you require any assistance, please contact this office at 305.673.7411 or at citvclerk@miamibeach.gov. Lobbyist w•Tucker Gibbs Principal Al Berg Issue • Amended on 11/9/15 say:All issues relating to the proposed CVS for the corner of 15th Street and Collins Avenue PLEASE COMPLETE THE SECTION BELOW Detail Compensation Received: i O.a CATEGORIES OF EXPENDITURES Food and Beverage: Entertainment: Research: Communications: / Media Advertising: Publications: Travel: Lodging: Special Events: CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE DATE REPRESENTATION ENDED: OATH State of Florida County of Miami-Dade I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed herein and any attachment hereto are true and correct. ,We o 4fL. k Lob gist Signature SIGNATURE AND STAMP OF NOTARY: Fb /P oduced ID ., . -, Form of Identification Signature of Public Notary—State of Florida Sworn to and subscribed before me Personally known ,,1111111 II LILLIAN BEAUCHAMP s Notary Public-State of Florida • • ; My Comm.Expires May 5.2018 411, ofl�l,��'' Commission # FF 115190