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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerk(olci.miami-beach, fJ, 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 COMMffiEE; 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 FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY
COMMISSION, OR A CITY BOARD OR COMMffiEE, 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 FH A "CERTIFI';ATE OF WITHDRAWAL."
1) Lobbyist Name: U00C)~'(,d'1 L.l!C\C,\ A
Last Name First Name Middle Initial
Business Phone Cf: j ) 'j -71. 06 0 ~ Message Phone (_)
Business Name and Address: G ~~i! r~( J T(QVf l'~
\ J.. 'l \ B ( \ l r<. (. \ \ A ...~I\ \.l.Q.. yvI\ t" yV\ I.
No. Street Suite City
Email Address: Dou')\Qr-\7 L@(j{\"vv ,C/iJ fV\.
2) Principal Retained by: Ue)(\.f) Gx,\ow,d Sou-!: L
II q ~Io)ASh !J. L.J~
Street
f:Jc h fL
State
FL
)-:)\') (
State
Zip Code
If different from above
y'V)ICir'Y1 )
City
Suite
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):
t>\st~NO- VOJ\\C'N( Q..
4, 'Identify each indMdual (Commissioners, Board, Committee, Authority member or City staff)
to ~ lobbied: ,
LoYY\W\\c.,c.... \ nY'\ 0 '\<.. ~'~<'I C n'tv"'\ \'V\' V\~P~
I
5, The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
D The City Commission
D City Commission Subcommittee
D City Staff
,,2!' City Board or Committee prl "'f Ad) 0Sr\~Il/'.
D Personnel
D Identify Others
on
on
on
on JI.J{',iL
on
on
.2001
.2001
: 2001
20Qj..
.2001
.2001
6, State the extent of any business, financial, familial, professional or other relationship which exists with any
individual identified in number (4) above:
N (')(V~ /
ON OCTOBER 1 Sf OF EACH YEAR,. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDnuRES 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 Section 2-482 of the Mi i Beach City Code as amended, and all reporting
requirements.
Signature of Lobbyist:
~ersonally known
D Produced ID
Identify
D Did take an oath, or
D Did not take an oath
State of Florida, County of Miami-Dade
swOrn!~/nd sUbscrilif!l!!:l~ ~e
This day of -V 20017.r
], .j',,'," ?SEAL
LEYLA1,:' '
NOTARY PUBUC s 11.0RIDA
':34
.',0 2,~"",~''''15
If Notary, print, stamp or type as c rImlrooMlilUIlSION
Registration:
~CEPTED
FOR CLERK'S USE ONLY
REJECT'ED DATE: 5 ~ 11 ~ Od--
If rejected, state reason:
Registration fee paid: [ es [ ] N
[ ] Cash
DATA ENTRY DATE: ,5'/2-.0
[ ] Not-for-Pr
Check ce #"
,-!6M- ENTERED BY: