Murano 3 LtdCity of Miami Beach Office of the CIW Clerk
1700 Convenbon Center Ddve, Miami Beach, FL 33139
Email: cityderkL~d.miami-beach.~.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
Check Box if an Amendment
NAME OF LOBBYIST: (Last} (First) (M.I)
DAV I ~ o ~ M/eel(
BUSINESS ADDRESS: (Number and Street) (City) (State)
TELEPHONE NUMBER:/.tut2. eT.~O4} (~16~ FAXNUMBER: t'l'Lft-o~
LOBBYZST RETAZNED BY:
DATE QUALIFIED ~/;7;Z~.~
(Zip Code)
EMAIL:
NAME OF PRINCIPAL/CLIENT:
BUSINESS ADDRESS: (Number and Street) (Oty) (State)
TELEPHONE NUMBER: FAX NUMBER: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
(Zip Code)
EMAIL: (Optional)
LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECiFiC LOBBY ISSUE:.,
Issue to be lobbied (DesCn.'be in detail):, ' '-~;' ';"
lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBlED:
A) Full Name of lndividual/'ritle
B) RelaUonship
iV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBY]ST COMPENSATZON (DZSCLOSE WHETHER HOURI, Y~
FL4T RATE OR OTHER):.
A) LOBBYIST DISCLOSURE:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): '3~ q(~O , ~0/~.X.-. ~ ' '
V. SZGNATURE UNDER OATH:
ON OCTOBER Isr OF EACH YEAR, EACH LOBBY/ST SHALL SUBHI'T TO THE CI'TY CLERK A S/GNED
STATEMENT UNDER OATH, LZST/NG LOBBY/NG EXPENDI'TURES TN THE CI'TY OF H/AHZ BEACH FOR
THE PRECEDING CALENDAR YEAR. '
.~ do solemBty, swear that all of the foregoi~g'fact~ are true and CorreL-l: b~l that Z 'H~ve 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: r'~ ~
Produced ID
.. : s ,. -- '~
Form of Identification
Personally Known
vzz.
State of Florida, County of Miami-Dade
subscribed efore me
Sworn to and :~~
This /~:; day ,2002.
SZGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
gna~~/~,,Bu"~liSer~~f Flod~'a
~, g,q~,'eaOct, 19,2004 ' '
· . ,, , . . .Illeta P
Print, ~~~.,' ry ublic.
FOR CLERK'S USE ONLY
Re.,=..,,o.:C . ,E ED DATE:
If rejected, state reason: ~ :
[ ] ~sh [ ] Ch~k HCR ·
DATA ENTRY DATE: ~~ ,2002 ENTERED BY
t First Revision - 05117/02