HomeMy WebLinkAboutJames Silvers
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerk@ci.miami-beach.n.U5 ' '.
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter i,:!bvision 3, S~on 2-481)
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CJ Check Box if an Amendment
NAME OF LOBBYIST:
(Last)
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(Number and Street)
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BUSINESS ADDRESS:
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(City)
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FAX NUMBER:
I. LoeBYJSr RETAlfts'7Jb.v-.s
NAM~ENT: ,
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~ ADDRESS: (Number and Street) (Oty) .. ......_ (State)
TB.E'J1,rN~ FAX NUMBER' (O".M')
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(Zip Code)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
. UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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~: II. SPECFlC LOBBY ISSUE:
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... Issue to be lobbied (Describe in detail):
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'.. III.
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CITY AGENClES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Titie
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER).
V,. SIGNATURE UNDER OATH:
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CL~RK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CIlY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of
familiar with the provisions
reporting requirements.
foregoing facts are true and correct and that I have read or am
ned in ction 2-482 of the Miami Beach City Code as amended, and all
Signature of Lobbyist:
Signature of Principal
VI. LOBBYIST IDE
'ct:
~ Produced ID
FLfV rl ~ Dr ,'\.J<e'('5 L l ro ))(\ J--.
Form of Identification
a Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Aorida, County of Miami-Dade
Sworn to and subscribed before me
,',--This'.::;'';? Y ,', day of ~~.~:mo.
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4 _;.'U"~ TONDA SHAW
, $rJ't; Notary Publlc:- State rl Aor\da .
. 1. .~ My CornrniIIlCnExpRlJU 21. 2IIlII
t~~ i Commlttlon' 001'0202
-~ Bonded By Natmnal NoIlIry AII/l.
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1';' , stamp or type name of Notary Public
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FOR CLERK'S USE ONLY
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Registration:
[~ED
[ ] REJECTED DATE:
DATA ENTRY DATE:
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ENTERED BY:
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If rejected, state reason:
Registration fee paid:
MCR
1 First Revision - 05/17/02