James F. Silvers Trustee
~
City of Miami Beach Office of the Oty Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityclerk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
-
(Oty of Miami Beach, Oty Code Chapter 2, Division 3, Section 2-481)
Cl Check Box if an Amendment
NAME OF LOBBYIST:
DATE QUAUFIED AS LOBBYIST
331
(Zip Code)
EMAlL:
I. LOBBYIST RETAINED BY: f\'~
~ /AU&] · J/LJ/~ 7 .. 't::
NAME OF PRINCPAL./CUENT: I . ... .,...
11tJ7J PIP';: Sfki/'\' F~
BUSINESS 3~ h 7z..(~'70? '-'3 dZ'-; b Ir-f" 1"''''
TELEPHONE NUMBER: FAX NUMBER: (Optional)
Y;;>/6'1
(Zip Code)
EMAlL: (Optional)
FIll out this section if prlndpalis a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
.,.,
"
II. SPEaFlC LOBBY ISSUE: .' , \ J
/7.A) f1t~tJ)L t3AtJ~@J~P ~JUb d()i{(/6AJ
Issue to be lobbied (Describe in detail): . , .'. ..f)P;JROz/IJ (",
III. CITY AGENaES/INDMDUALS TO BE LOBBIED:
A) Full, Name of Indlvldual/ntle
B) Relationship
If .-
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL ~
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: 6 .
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
6
"
v. SIGNATURE UNDER O~TH:
---<.:: \ '\ , --'
ON OCTOBER 1 Sf OF EACH YEAR, EACtf lOBBYIST SHALL SUBMIT TO THE Crrv' 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 containe In . 482 of the Miami Beach City Code as amended, and all
reporting requirements,
Signature of Lobbyist:
--\
..
. ,
Signature of Principal/Clieri't: '
VI.
LOBBYIST IDENTIFICATION:
'.
"";KP Produced ID
J:""L~ y',do.. l>v;vclr.(S
Form of Identification
L I ~2.. -(\(l J--
Q Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
.This ;.:2. <-{ .'day of ~V'/\bA" 26
~~
-
.H..!!to TONOA SHAW
I r\ Notary Public - State d florida
i. . i-My CarnrnIIIIan I:JpB JY 2'1. 20118
. - Commission' 00130202
Bonded By NIItIInaI NoIIIy Alan.
/" . ~,Signature of Public Notary - S~te of Florida
" "'-=mrx::Jpl~ SI4A\J\.:j
.. Print, stamp or type name of Notary Public
~
~
;
/ FOR CLERK'S USE ONLY
- Registration: - 't'1 ACCEPTED [ ] REJEcrED DATE:
q p!/P?/
If rejected, state reason:
Registration fee paid: Yes [ 1 No
A~h } /l Check MCR
pATA ENTRY DATE: ~ Pf/ 6-;;;r-, 2~02 ENTERED BY:
1 First Revision - 05/17/02