James Silvers, Trustee
Sep-26-02 08:46A Rosen Switkes & Levinson 305 5385578
P.02
City of Miami Beach Office of the City Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emall: dtyclerk@ci.miami-~ach.fl.us
lOBBYIST REGISTRATION FORM
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(Oty of Miami Beach, aty Code Chapter 2, Division 3, Section 2-481)
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS ADDRESS: (Number and Street) (City) (State
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TELEPHONE NUMBER: FAX NUMBER:
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(M.!) DATE QUAUFIED AS LOBBYIST
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EMAIL:
L LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CUENT:
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Sr;
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(Oty)
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3113 Cj
(Zip Code)
BUSINESS ADDRESS:
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TELEPHONE NUMBER:
(State)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2.482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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. UST ALL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Desaibe in detail):
ID. CITY AGENCES/INDMDUALS TO BE LOBBII!D:
A) Full Name of Indivldual/ntle B) Relationship
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Sep-26-02 08:47A Rosen Sw;tkes & Lev;nson 305 5385578
.
P.03
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSe WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBY1ST DISCLOSURE:
11/0 ~~~(!$VS ,q-rt''<> ('J
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH_YEAR, EACH LOBBYIST SHALL SUBMn TO THE OTY 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 foregoing facts are true and correct and thz: ~ have read or am
familiar with the provisions contained in Se ion. 2-482 of Miami Beach City :=de as amended, and all
reporting requirements,
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Signature of Lobbyist:
c Produced 10
Form of Identification
rr/ 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 ':<'7 day of 5epf-. ,2002.
JEANNE L TURK
MY COMMISSION # DO 139260
El\PiI1ES: September 19, 2006
Bonded ThtIJ Notal}' PubIlc Underwriters
Print, stamp or type name of Notary Public
Registration:
FOR CLERK'S USE ONLY
[ ] REJECTED DATE:
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If rejected, state reason:
Registration fee paid: [ 1 Yes [ ] No
[ ] Cash [ Check MCR #
DATA ENTRY DATE: 2002
1
I F'nt RevisIOn - 05/17/02