Renovation/1058 Collins 1/29/2
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk@ci.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 COMMmEE; 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 COMMmEE. 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: G-or\"~ A \e:z. 52.. ~\~dO
Last Name First Name Middle Initial
Business Phone ~ G,., ~ - <6'1 0 "1 Message Phone (~
Business Name and Address: -l)~u\ tJ" S &.~ e.. J Tn Q. ,
\ \054 M-eeAcll~V1 ~\le.. ME . t=' \
No. Street Suite City State
33l6'1
Zip Code
Email Address:
2) Principal Retained by: -.D(lo....u " b s
--
---
ci to...t='e.. J .in (l. .
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. .., G./
Al..~edo (-n,(\7~l'€ I 58"J..S &l \ilt\s. ~oe.. \>h-~~ I \='L ~3l.1.o
3) Subject Matter (Describe in Detail):
l^enou~-\iaV\ i1J..'e5oRfA.-h'..~1l IDS?? &111 H.5 -Aue...,
I
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: \ . J () l) t
H-\5toe..\C. '?1t.'e~ev",~OV\ ~-t-~ . ~~ICj\'\ K.'eV'I~t.U I7>O!l'Qd
J
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
Q The City Commission
Q City Commission Subcommittee
Q City Staff
. City Board or Committee
Q Personnel
Q Identify Others
on . 2001
on . 2001
on . 2001
on 3 - l '- . 200; ~
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: Un 1)"e-
ON OCTOBER 1 sr 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 Sectio 2- 2 of the Miami Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
(' Personally known
Q Produced ID
Identify
a Did take an oath, or
a Did not take an oath
J
If Notary, print, stamp or type as c.
BERnIA HIlNDEVADT
,.. MY COMMISSION I CC 848243
: . IRES: Oclaller 22. 2llO3
FOR CLERK'S USE ONLY
Registration: ~CCEPTED [] REJECTED DATE: D ~
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-fur-Profit ~g~Z.aQOA.:\aY' _
[ ] Cash ~ Check MCR # 01- _ u ~
DATA ENTRY DATE: .2001 ENTERED BY:
.
f\
""
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
N~ 240296
D Cash D Credit Card ~heCk #
For
Preparer: