Clear Channel, Martina Schmidt
m
~
-
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityclerk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
K5 Check Box if an Amendment
S'E-l'-l-S Ic:::x:.---N \
NAME OF LOBBYIST: (Last)
Pi.A-p-"Vr
(First)
(M.!) DATE QUALIFIED AS LOBBYIST
2:>3\bl
(State) (Zip Code)
\ \ 1-5 ~~P::-t'-!I {iDN2Gl M I h-.cs:::l1
EMAIL:
..55ClE::::>4.2.-t q"b:J\ H fjl,~ \ '""FL--
BUSINESS ADDRESS: (Number and Street) (City)
~./5 .:.:? --=l- 2.... .
FAX NUMBER:
~:::>..s 2:::>-=t-Z-
TELEPHONE NUMBER:
1512-
I. LOBBYIST RETAINED BY:
C\.-:E~\2.. C.rl~-PI~-nNA-~IP'iIC.:ji-. ~\02- ylCE.....~c...c.~
NAME OF PRINCIPAL/CLIENT: ~~?\N~';:".c:;::= ~V = i r'f=="-...~r
\ \0 t:p...=S'- 4.z...N<d ~~'sET, lBIMFl-OClf-. NE.w y~ NY itO\1-
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip code)
2.. \2- C'-V:=\- z.. I Ct:::i=t S 2.. \ 2..... 8 I B C0\ P, f"'\A-p.J)NA-6:..H fllDT P
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) c::::::.1-~h"\'NtJE.L I
~
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (e))
? NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
:r::R e -'l=\LE-}.\O 1.5 4 4~ 'F-F-q p.d~ ~ <Sn~~-e::, f'I1-.}p
Issue to be lobbied (Describe in detail): C:::::;~ Y-l\C':::'~ ~ ~ ~
1=-\~~-e:. ~= ~Nrtu,.2..€-
m. CITY AGENClES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/Tltle B) Relationship
~e::;\91'-JPcvIEVy' E::r-~1 ClN P'iAj'z.J1 u:::cz.
tjlES.T'C.9--1C- f'~~~ ~~ ~02a: ~
~y ~~;r=~Yie:en~~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATlON (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: ,-4-.- ~ NO ~~ '~D\O e:E.. 1"'1Ei2-F
T~ A-....,J _
,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 17 0
rLflcnd ?>R8! IIPb iu~n'7.s
C tJ/Y) pe /1 salf t'n
,
To
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, L15nNG 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 provision ontained in Section 2-482 of t~Miami Beach City Code as amended, and all
reporting requiremen : ~ .
Signature of Lobbyist: "
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATlON:
~ Produced ID
Form of Identification
)( Personally Known
YD. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade ,
Sworn to and sUbSCribe~oie m,e
This ~O day of. 2002. :I) . ~
~ /:J~
Signature of Public Notary - State of Florida
~-
t * ~ CommI..ion CC8eII8f~
Print, stamp or type'" a ~~bWJik
FOR CLERK'S USE ONLY
S/2J(OY
I I
Registration:
['~CEPTED
[ ] REJECTED DATE:
If rejected, state reason: ./'
Registration fee paid: ~~[ ] No "1, J, Ir-
L"-fCash [ ] Check MCR #CX 'i-lK)
DATA ENTRY DATE:
1
.2002
ENTERED BY:
1 First Revision - 05/17/02