David Lifschultz, President
~
-
City of Miami Beach Office of the City Oerl<
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerl<@ci.miami-beach.f1.us
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:
CII~/m,4J.
(Last) (First)
430IADI1U~ AV~ M,g.
(Number and Street) (City)
786 ::303 5358 ~Q) 613 58B~
TELEPHONE NUMBER: FAX NUMBER:
An 1"'5
(M .1)
DATE QUAUAED AS LOBBYIST
-:3:? /40
(Zip Code)
A1KINJ (fi) ST/S. /'JET.
EMAIL:
BUSINESS ADDRESS:
FL.
(State)
1. LOBBYIST RETAINED BY:
l:JA V i""~ L IF .:::!>C/I u L -rz...
NAME OF PRINCPAL/CUENT:
fj(l5.
945 fl1 /Cf//?,If;J~ }1 s5Q J;J (
Z4-Q8 p-KAflE"
BUSINESS ADDRESS:
Avt31lu~
(Number and Street)
HIIIUI13el1C11 FL.
(City) (State)
3:3 14-0
(Zip Code)
30$ S3+' 0/0
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If prindpal Is a Corporation, Partnership or Trust [Section 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEACIARY:
. us,- ALL PERSONS HOLOING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECFIC LOBBY ISSUE:
N:E:=tJ eoND:::> PRo~ t- ocH1liJ;
Issue to be lobbied (Describe in detail):
A'f 94-5 HIC///~/I.J IIVG
III. CITY AGENCES/INDMDUALS TO BE LOBBIED:
A} Full Name of Indlvidual/ntle
B) Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
F L.A-r
~ ,47l3
.
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
$"30,oC)C)
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V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL sUBr.tlr'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 foregoin facts are true and correct and that I have read or am
familiar with the provisions contai on 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
~~~CII~/f 1'1550.
Signature of PrincfpaljOient: ~~
LOBBYIST IDENTIFICATION:
INC.
VI.
X Produced ID
~ ~S-ID4-(PZ--+4f.,-O
Form of Identification .
~personallY Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn tcr;nd subscri~~~.~t,:"/e
This ~day Of~ 2002.
1lJ hIeIte a.o
;. c ~ j My CoI...1IIIIon 0012418'1
~..." ExpIres FebruIry 17 2004
i) ~C,!"r;~,..
r.. , . My "'.'.....'.'.."'...-.<.."'.bD12
\; ~ ~.. ae7
~ .ebtUerY 17 2004
({ij
Signature of Public Notary - State of Rorida
',.' .,' ~ Gla(l)
Print, stamp or type name of Notary Public
,
FOR CLERK'S USE ONLY
Registration: t><1 ACCEPTED [] REJECTED
DATE:
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If rejected, state reason:
Registration fee paid: MYes [ ] No f).. t-:r l a'A
[ ] Cfsh .t><J Check MCR #7'";) -u
DATA ENTRY DATE: q I ~ " 2002 ENTERED BY~ I jo
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I First Revision - 05/17/02