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Restoration 1058 Collins1/29/02 ., " CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 cityclerk(ii)ci. miami-beach.f1. us AFFIDAVIT LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIACATION OF ANY ORDINANCE, RESOLUTION, AmON OR DEOSION OF ANY COMMISSIONER; ANY AmON, DECISION, RECOMMENDATION OF ANY cm BOARD OR COMMmEE; OR ANY AmON, DEOSION OR RECOMMENDATION OF ANY PERSONNEL DEAN ED IN ANY MANNER IN THIS SEmON, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING PROCESS ON SUCH AmON, DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION, OR A CITY BOARD OR COMMmEE, THE TERM SPEOFICALL Y INCLUDES THE PRINOPAL AS WELL AS ANY AGENT, ATTORNEY, OFACER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING AcnvmES FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO ALE A "CERTIACATE OF WITHDRAWAL." 1) Lobbyist Name: Gov)'l.~\'ez. 'Al~do :r. Last Name First Name Middle Initial Business Phone ~) "'1C)<? - <lS1-.\ '3~ Message Phone L) g...M.. 'C.. Business Name and Address: ~v \ D's c...~ r -e.. I T(')c. \(054 ~'e2-(eli 'l\Vl ~\-Ue. J.A. ~ . No. Street Suite Oty Email Address: ~~ &.1.. e. ~e" beAc~. ()e.. + 2) Principal Retained by: t) ~ \oJ i D .5 r .A F ~ J T () c. . FL State '"3"'5 I L.f 0 Zip Code If different from above Street Suite City State Zip Code (a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner, beneficiary or interests. t\ \ M4e-c\o ~ ~\.e,- c;~, " il1 S A tJ e h -A M.:B ( PI "$3/ i.j. 0 3) Subject Matter (Describe in Detail): ~-e\'\ O\) f:\.-\\ OY\ / ~ e.'5 b 2 -ht..:tl 0\1\ lPS~ r~~\l",<; Rve. . '\.. 4. Identify each individual (Commissioners, Board, COmmittee, Authority member or City staff) to be lobbied: n I , '""i"'\ ("), f'\ A l-\-i'StnR-ic" ~'5'e~~",,",'Oll\ Bof>,.~cll \...I"f"~l~1I1 1CeUI'€c..u l)o~~_ ~ ~ 5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or individual): a The City Commission on .2001 a City Commission Subcommittee on .2001 a City Staff on .2001 . City Board or Committee on "3-1'- . 200lZ- a Personnel on .2001 a Identify Others 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: t'\Ol\'f- ON OCTOBER 1 Sf 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 famillar with the provisions contained in Se ion 2-482 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: 4 Personally known a Produced 10 Identify a Did take an oath, or a Did not take an oath HUNDEVADT MY COMMISSION. CC 848243 ~XPIAES: October 22, 2003 If Notary, print, stamp or type Registration: ~ ACCEPTED If rejected, state reason: Registration fee paid: [ ] Yes [) f}o [] Not-for-ProfjtRrg~niza~e.. [ ] Cash ~ Check MCR # ~~ \)~ .2001 ENTERED BY: FOR CLERK'S USE ONL \. t [ ] REJECTED DATE: 'D\ \ ~ ~~ \ I I I I DATA ENTRY DATE: