Delano Hotel c/o Robert Todak
co,
~
Oty of Miami Beach Office of the Oty aerie
1700 Convention Center Drive, Miami Beach, FL 33139
Emall: dtyderk@d.miami-beach.n.us
LOBBYIST REGISTRATION FORM
-
(Oty of Miami Beach, Oty Code Chapter 2, Division 3, SectIon 2-'181)
... Check Box If an Amendment
lifp.,~/VLU/I 'nU a
NAM OF LOBBYIST: (Last)
, ..inr:1cha r
(First)
~
tJ.
(M.I) DATE Q.J~c;t AS LOBBYIST
(.en$) ~)Jo:- r l/..2-
TELEPHONE NUMBER:
(Oty)
I.:bs)::;,~,.,- III'"
FAX NUMBER:
4 .tfJ~v.4n
EMAIL
L LOBBYIST RETAINED BY:
-'1Jo^n ~w
NAME OF PRINOPAl/OJENT:
e..Io ~+ ~_
~ r J., '
IhRt(" tIlJLu'/\ \JJVJ.l.JU r fult.:l-YU
BUSINESS ADDRESS: (Number and Street) (Oty)
l3.oc:::. ) ~ '/4- G I ~;J, [30 S'J ""l~- fJeA B
TELEPHONE NUMBER: FAX NUMBER: (Optional)
I:u Qj ~
(State)
~ -3313 <7
(Zip Code)
EMAIL: (Optional)
FIll out tills RCtion If ~ Is. CoqaantIon, hrtMrlhlp 01' TnIst [Sectfon 2-482 (e))
? NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
Von~
? UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
n. SPEaFIe LOBBY ISSUE:
. "
J.v.4 1"~' L..J.I\.A. I DJ") a f'..d '-'F'~n- lJ /) A.J' '.0
Issue to be lobbied (Describe in detail): .........,.
m. ClTY AGENaES/INDIVIDUALS 10 BE LOBBIED:
A) FuD _me tIIlndlvldu../11tIe
B) ReIMIonIh/p
06-26-2002 05:04PM FROM-TEW CARDENAS REBAK
+3055361116
T-303 P 003/004 F-055
lV. DISClClSlIU Of 'ftIlMSAIID AMCIUlInSOF LOIa:ftS1' ~~ -WllElHER 1f000RL Y.
FLAT RATE 011 OTHER):
II) L08llVJST OfSCLOSUllf;
&vltJ l-~~ cf~.Cil
8) PlUNCIPAI. 'S OISa.OSURE (OF LOBBYIST COHPENSATlON):~ ~.
V. stGNAl1.W! uMDtIl OAlIft
ONOaollflu5ror DOt- ~-I!ACN LO..nSUIlALL SUBMIT TO 1'MIM:In' ClBQ( A SIGNED
STAlDIENT UNDER GAlli. LISI1ftG LOIIlIYlJIG IiXPBIDnuAES JIll TIll! C11Y OF MIAMl8EAClt FOR
THE PAKEfING ~I fJiIr1R ftAR.
I do solemnly swear that all of the foregoing facts are true and correct arnt, that 1 nave read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements. ~__./
SigrtlJture"of\:obbyi51:: -- V
Signature of Principal/Client:
VI. u.ansr 1DEllllFlCA1IOII~
<It ProducedID
Form of Idt:"UfK.;dtiun
~,~
YD. ~AIID~OFffIIf-rOllllU'VlTaalC:
State of Florida, ,COunty of Miami=Oade
~ tQ~SUbscr__ lbef~me
ThIS-- LL day of.~ -.2OOL
Print, stamp or type na
fQlU:1EM'S USE~"-
Registration: [1 ACCEPTfD [1 RElECffD DATE:
If rejected, sratl! reason:
"egi.t>";_Mpatdl [-+ves--[ }M&-
!..,1 ?,sh [ } Chedt
PATAENlRYOATE: -1j,1
MCIl. .,
.2002
I J';rst Revision - 05/17102
\ "
IV. DJSCI O5llU OF TERMS AND AMOUNIS OF L088YI5r COMPEN5Al1ON (DJSCI 05E WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
}\;w~ l JUtdL ~ 4f ~.a.u
B) PRINCIPAl'S DISUOSURE (OF LOBBYIST COMPENSATION): cf ou...dJ
WI 4'VI (J D. ~_
.
V. SlGNA1UIU! UNDER OATH:
ON OCTOBER 1<< OF EACH YEAR, EACH L088YJST SHALL SUBMIT TO THE CITY a.ERK A SIGNED
srA1l!MENI' UNDER OATH, LJSnNG 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 Oty Code as amended, and all
reporting requirements. "...-..../
Signature of Lobbyist: - V
Signature of Principal/Client:
VI. LOBBYIST IDEN11I'ICA110N:
IS Produced ID
Form of Identification
~naIlY~
YD. SIGNATURE AND 5rAMP OF NOTARY OR DEPUTY a.ERK:
Print, stamp or type na
State of Florida, County of Miami-Dade
Sworn 2!nd SUbscri~ me
This day of . 2002.
FOR a.ERK'S USE ONLY
Registration: [] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No
[ ] Cash [ ] Check MeR #
DATA ENTRY DATE:
I
.2002
ENTERED BY:
I First Revision - 05{17{02
D6~t8-tOOt 05:04PM FROM-TEW CARDENAS REBAK
+3055361116
T-303 P 004/004 F-055
STATE OF FLORIDA, COUNT'.( OF MIAMI-DADE
SWORN TO AND SUBSCRIBED EFORE ME
THIS :J- r::?DA Y OF ,2002.
u,/
~
TANIA LEE RNASA'J
NC:JrAWiPUBUC Sf ATE OFFL(lIlDA
a>>OftiSION NO. ~ ..
MY~lON