Echo Complex dba Echo Unltd.
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@d.miami-beach.fl.U5
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2.481)
o Check Box if an Amendment
NAME OF LOBBYIST:
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(First)
(M.I) DATE QUAUFlED AS L088YIST
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BUSINESS ADDRESS:
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I. LOBBYIST RETAINED BY:
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NAME OF PRlNOPAl/ ENT:
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EMAlL: (Optional)
Fill out this section If prlndpalls a Corporation, Partnership or Trust [SectIon 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. UST ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II.
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/TItle
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOROTHER)
A) LOBBYIST DISCLOSUR~ '1 s{), 00
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B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 provisions contained in Sectio -482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Slg_"'ofPri"dpaVd~"" ~~ ~~
VI. LOBBYIST IDENTIFICATION:
o Produced ID
Form of Identification
o Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 2002.
Signature of Public Notary - State of Rorida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: [vI'ACCEPTED [] REJECTED
DATE: ~, S! O"Z....
If rejected, state reason:
Registration fee paid: M Yes [ ] Ny
[ ] Cash [VJ Check
MCR # -z.,4\.f S'Z. ~
DATA ENTRY DATE:
1
.2002
ENTERED BY:
1 Rr5t Revision - 05{17{02