HomeMy WebLinkAboutFirefighters of Miami Beach
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City of Miami Beach Office of the City Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@d.miami-beach.fl.u5
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, S~on 2-481)
Q Check Box if an Amendment
Hill;i.ard
NAME OF LOBBYIST:
(Last)
Randall
(First)
L. 9/6/2002
(M.!) DATE QUAUAED AS LOBBYIST
600 NE 36th Street, #304 Miami
BUSINESS ADDRESS: (Number and Street) (City)
(305) 673-5353 (305)673-5352
TELEPHONE NUMBER: FAX NUMBER:
FL
(State)
33137-3950
(Zip Code)
rhi11iard@ao1.ocm
EMAIL:
I. LOBBYIST RETAINED BY:
Firefighters of Miami Beach Ibca1 .i510
NAME OF PRINCPAL./CUENT:
PO Box 403518
BUSINESS ADDRESS:
(305) 637-5050
TELEPHONE NUMBER:
Miami Beach
(Number and Street) (City)
(954) 961-3601
FL
(State)
33140-1518
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if prlndpalls a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY:
. UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEaFIC LOBBY ISSUE:
Budget concerning Fire Inspectors
Issue to be lobbied (Describe in detail):
DI. CITY AGENaES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/ntle B) Relationship
City of Miami Beach Staff None to any member of staff
City of Miami Beach Mayor and Camlissioners None to the mayor or carmiss.
OIlers
'N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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. I ~ '
Signature of Lobbyist: ~
Signature of PrlndpaVd'tent:~~
VI. LOBBYIST IDENTIfICATION:
~ProducedID ~L+r~~3 -c.fu-S'l'" o"2.-i-O
Form of Identification
~ Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and SUbscri~e
This 01 <<, day of 2002.
OFFICIAL NOfARYSEAL
LILLIAN BEAUCHAMP
NOfARY PUBUC STATE OF FLORIDA
COMMISSION NO. D0109289
MY COMMISSION EXP. APR. 29,2006
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Signature of Public Notary - State of Florida
Li \ l\~1?>eA\)cl-v:.1Yf
Print, stamp or type name of Notary Public
Registration: [ ~ED
[ ] REJECTED
FOR CLERK'S USE ONLY
DATE: g)q I~
If rejected, state reason: __
Registration fee paid: '1] Yes [ ] No
[ ] Cash ~eck
pATA ENTRY DATE: ..:J{q.
MCR~R I
ENTERED BY.;J1 /b.
-
.2002
1 First RevIsion - 05/17/02