HomeMy WebLinkAboutMurano Three, LtdCity of Miami Beach Office of ~e Oty Clerk
1700 Convention Center Drive, Hiami Beach, FL 33139
Emaih cib/clerk~ci.miami~beach.fl.us
LOBBYIST REGTSTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2481)
n Check Box if an Amendment
NAME OF LOBBYIST: ) (First) (M.I) DATE QUALIFIED AS LOBBYIST
BUSINESS ADDRESS: (Number and Street) (City) (State) /b//~p Code)
TELEPHONE NUMBE~: FAX NUMBER: EMAZL:
Z. LOBBYZST RETAZNED BY:
NAME OF PRINCIPAL/CUENT:
BUSINESS' ADDRESS: (Number and Sb'eet) (Ci te
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(Zip Code)
EMAIL: (Optional)
Fill out this section if prlndpal 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 T~UST:
IX. SPECZFXC LOBBY ISSUE:, ,, ,. '
IssUe to be lobbied (Describe in detail): , ' ':-; '.' - · "
CTrY AGENCZES/INDIVIOUA'I,S TO BE LOBBIED;
A) Full Name of lndivtdual/TIUe
B) Relationship
1V. DZSCLOSURE OF TERNS AND ANOUNTS OF LOBBYIST CONPENSATZON (DZSCLOSE WHETHER HOLIRL Y~
FlAT RATE OR OTHER,):.
A) LOBBYIST DISCLOSURE:
B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION): ~' ~yy O~o/~ .
V. S~GNATURE UNDER OATH:
ON OCTOBER Isr OF EACH YEAR, EACH LOBBYIST SHALL SUBMI'T TO THE CITY CLERK A SZGNED
STATEMENT UNDER OATH, LZSTING LOBBYING EXPENDITURES i'N THE CITY OF MZAMZ 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 2-482 of the Miami Beach City Code as amended, and all
reporting requirements~_/~
Signature of Lobbyist:
[] Produced ID
Form of Identification
~--Personally Known
VZX, SZGNATURE AND STANP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
day ~~, 2002.
Sign
FOR CLERK'S USE ONLY
Registration: ~PTED [ ] REIECTED DATE: '(0 ~Jrg'e('~/"'
If rejected, state reason:
~//~ ~/~ ] Check
] ~'~ " 2002 ' ENTERED BY:
?ATA ENTRY DATE:
First Revision - 05/17/02