Collins Ave Assoc. LLC
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oty ci Miami Beach OffIce ci the oty aerie
1700 Convention Center Drive, Miami Beach, R. 33139
Emal: cityclerk@cl.mIaml-beach.n.us
LOBBYIST REGISTRATION FORM
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(oty ci Miami Beach, oty Code OIapter 2, 0MsI0n 3, Sectian 2-481)
It Check Box if an Amendment
Revuelta
NAME OF LOBBYIST: (Last)
Luis
(First)
2560 SW 27Avenue
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
(305)
FAX NUMBER:
Florida
(State)
529-2022
(MJ) DATE QUAlIFIED AS LOBBYIST
33133
(Zip Code)
(305) 529-1080
TELEPHONE NUMBER:
EMAIl.:
L LOBBYIST RETAINED BY:
Collins Avenue Assoicates, L.L.C.
NAME OF PRINCPAl/OJENT:
100 SE 2nd street
Miami
Florida
(~tate)
33131
BUSINESS ADDRESS: (Number and Street) (City)
(305) 995~5330 (305) 995-5340
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(Zip Code)
EMAIL: (Optional)
Fill out this section If principal Is a Corponotion, Partnership 01' Trust [SettIon 2.....2 (e))
7 NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Don Peebles
UST AU. PERSOI'6 HOLDING. DIRECTt Y OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SlJcH
CORPORATION, PARTNERSHIP OR TRUST:
IL SPEaFIC LOBBY ISSUE:
Historic Preservat,ion Board mo(Ufication application
Issue \10 be lobbied (Desalbe in detail):
UI. cnv AGENCIESfINDMDUAlS TO BE LOBBIED:
A) FuU Name of IncliYIdualf1ltle B) RIllatlonshlp
Jorge Gomez, Director None
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Tom Mooney None
Armando Valdes None
William Carey None
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'IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISO.OSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
A) LOBBYIST DISC.OSURE:
HourI
B) PRINCIPAl'S DISClOSURE (OF LOBBYIST CDMPENSATION):
Hourly
V. SIGNA1UREUNDEROA1H:
ON OCTOBER 1ST 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 Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
_of_ ~
_of_~
VL LOBBYIST IDENTlFI ON:
e-
~ Produced ID
Form. of Identification
~ Personally Known
VD. SIGNA1URE AND STAMP OF NOTARY OR DEPUTY a.ERK:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This. ~8'J-k day of r ,2002. ~ UJ~.o./ /L- ~ ~;- '-
" '0 ~~~_H~ ~re of ,"bUt N"",'l' - ~of F10rida -----
0'" ..~ MICHELLE D KOH~ER
~~.' (l C<*MISSlON NUMIIEA
~ .I.: ~ CC186688
"1- ~ MY COIoIMISSIONEXPlRES Print, stamp or type name of Notary Public
OFf~O OCT. 28,2002
::r: CLERK'S USE ONLY.
Registration: ~ ACCEPTED ~RfJECrED DATE:
If rejected, state reason:
Registration fee paid: ~es [ ] No
[ ] Cash ~ Check MCR #
1-)" -Oil-
'lSLkI:;Tt)
DATA ENTRY DATE:
1
.2002
ENTERED BY:
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I First Revision - 05/17/02
'j ~.~ BV: BERCOW & RADELL, PAj
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3053778222;
JUN-28-02 3:58PMj
PAGE 3/5
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IV. DISCL05U1l1: or TERMS ANO AMOUNlS of L~IYJST COMPENSAnON (DISC1OSE WItflMER HOIIIlLY,
FLAT RA1Ii OR Q1HERJ;
A) LOeIVlST OISQ.ClI5\JRE: Hour 1 v
$185.00
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I) 1'RINCII'''l. os OISQ.OSURE (OF LOlIBYIST CDHPENSAT1ON):
Hourly $185.00
Y. SIGHATURE lIl'lDER OAtH.
ON OCTOIIER 1" OF IACHYEAR. EACH LOHYIS1' SHALL SUBMI1' TO THE CITY a.ERKASlGNED
STATEMeNT UNDER OATH. LISTING LOBBYJNG EXPeHDD'URES IN THE C1TY OP MIAMI BEACH FOR
'tHE PRECEDING CALENDAR YEAR.
I do SOlemnIV swear thal ~of the ~1ad5 an: true and com:ct and thaUhave reiId or am
familiar with the plOYlSlons contained in Section 2-482 of the Miamllleach City Code as amended. and an
reponlng .I'IqUlrements. .
S_of_~'~~
Signature of Pr1ndpaVCIient:
VI. L~ IDINT1flCA1lON:
~,
~ Produced 10
Form of Identification
6! Personally Known
VII, SIGNATURI ANI) STAMP OF NOTA'" OR DEPutY CUJU(l
State of Florida-, County. ofMlami-Oade
Swom to and subscribed before me
ThiS 27 day of ~.2002.
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FOR CLERIC'S ~ ONLY
Rl:\listrilllcn: .Pq" ACCEl'TED (] RE1fCTED
DATE: 1 Ji --()02.-
It n:jeCted, Slltllt _on:
~lst1allcn fee paid: MVes [ ] No ^ tI Lc' <\
( ] Cish ~ 01ed\ Mt:;( , ',.(..L4..oL ~ !..!
DATA EJ(I'RY DATE: . ZOO;l ENTERED BY:
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I I'IBt RcvIIiaiI _ 05/17~1