Fisher Island Holdings 03/20/2
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk(Ci)ci ,miami-beach, f1.us
AFFIDAV1T
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, ACTION OR DEOSION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMmEE; OR ANY ACTION, DEOSION OR RECOMMENDATION
OF ANY PERSONNEL DEANED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-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 SPECIACALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATTORNEY, OFACER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVITIES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFACER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A
LOBBYIST IS REQUIRED TO ALE A "CERTIACATE OF WITHDRAWAL."
1) Lobbyist Name: g 4L S bl<4t !Iv HLt;-'"PiJ
Last Name First Name Middle Initial
Business Phone (goS") l(L({ -I 'L7'L Message Phone~
Business Name and Address: 3' b ? S"'L./ 0" Sf S-v(?€ ~'7!J
"/~""I h :rs,sr
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No. Street Suite City State Zip Code
Email Address:
2)
Principal Retained by:
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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): 11 1~
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( s".{ va r '" A IN f(:;-vJ h-.rJ elF
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4. Identify each individual (Commissioners, Board, Committee, Authority member or City stLff)
to be lobbied: /"
UOr-,{) ,{Sf"'" f- I1-ohf.tJ.
S. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
0 The City Commission on .2001
0 City Commission Subcommittee on .2001
Q City Staff on . 2001
Q City Board or Committee on . 2001
0 Personnel on . 2001
Q 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: _
pJO N C
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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 containedco'n S . io -482 of the Miami Beach City Cod.e as amended, .and all reporting
requirements. r? c;/'
Signature of Lobbyist: ~ Q J 0'<
Q Personally known
)4 Produced ID
~ Did take an oath, or
Q Did not take an oath
Identify
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This :2.IrtP day of ~ . 2001.r-
~uJ~
Notary or Deputy Clerk
~
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: [11 ACCEPTED [] REJECTED DATE: S/?--V / d :2--
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit orgapi~9.0.I},D
[ ] Cash [ ] Check MCR # :;J, ~~b(~_
DATA ENTRY DATE:
.2001
ENTERED BY: