HomeMy WebLinkAboutMurano 3 LtdOty of Miami Beach Office of the Oty Clerk
1700 Conventjon Center Ddve, Miami Beach, FL 33139
Email: cib/derk@d.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, DMsion 3, Section 2-481)
Check Box if an Amendment
NA~st) ~
(M.I) DATE QUALIFIED~ LO~..~ST
TELEPHONE NUMBER: P~ NUMBER: ~M~L:
Z. LOBBYIST RETAZ~
NAME OF PRINCIPAL/CL]ENT:
BUSINESS ADDP, ESS: (Number and Street)
TELEPHONE NUMBER:
y,_
(oty) (State) (zip Code)
FAX NUMBER: (Optional) EMAIL: (Optional)
fill out this sectdon if pHndpal is a CorporaUon, Partnership or Trust [Section 2-482 (c)]
, 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:
SPECiFiC LOBBY iSSUE:
Issue ~ ~ Iobbi~ (~in ~il): , ' . ':,
IlL ~ AGEN~ES/IND~DUA~ TO BE LOBBIED:
A) Full Name Of %ndividual/'1'iUe
B) Relationship
IV. DTSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATION (DTSCLOSE WHETHER HOURLY/
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: ~ ) l;~3,C~oO/ , ,
V. SZGNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR, EACH LOBBY[ST SHALL SUB!4Zl' TO THE City CLERK A S~GNED
STATEMENT UNDER OATH, LZST[NG LOBBYING EXPENDTrURES IN THE CZ'ff OF MZAM I' BEACH FOR
THE PRECEDZNG 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-'~82 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist: ~, '~ ~
Produced ID
a~Personally Known
Form of Identification
State of Florida, County of Miami-Dade
Sworn to and subscribed efore me
This / ~ day of ~x~z ,2002.
SIGNATURE AND STAMP OF NOTARY OR DEPtJ'rY CLERK:
Print, ' ' ~ ue , ,~ary Public
FOR CLERK'S USE ONLY
If rejected, state reason:
;-'-2
~DATA ENTRY DATE: 002
First Revision - 05/17102