Portofino Towers Condo Ass'n
in
City of Miami Beach Office of the Oty Clerk
1700 Convention Center Drive, MiIlmi Beach, Fl33139
Email: cityderk@d.miami-beach.f1.us '
LOBBYIST REGISTRATION FORM
-
(City of Miami Beach, Oty Code Chapter 2, Division 3, Section 2-481)
CI Check Box if an Amendment
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NAME OF lOBBYIST: (last)
ISO W;::
BUSINESS ADDRESS: (Number an
'3tJf 3:7/"2:2-2-3
TELEPHONE NUMBER:
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NAME OF PRINCPAljCUENT:
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BUSINESS ADDRESS: (Number and Street)
~(JJ 531/- '1'12-7-
TELEPHONE NUMBER:
(First)
I "u'~ -L
Street) City) (State)
3tJf 5':;-;.. ~r3
FAX NUMBER:
(M.I) DATE QUAUFIED AS LOBBYIST
33/'30
dAti t:; Code)
EMAlL:
I.
(Cty)
R 33(3;
(State) (Zip Code)
FAX NUMBER: (Optional)
EMAll: (Optional)
Fill out this section If principal is 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.
~LDB8Y ISSUE'
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Issue to be lobbied (Desaibe in detail):
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III. CITY AGENCES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
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A) LOBBYlSTDlSClOSURE, )2.J Atp.( aJ a TTe1RNj
B) PRINCIPAL 'S DISCLOS~ (OF LOBBYIST COMPENSATION):
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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.
Signature of Lobbyist:
have read or am
ode as amended, and all
I do solemnly swear that all of the foregoing fa
familiar with the provisions contain i
reporting requirements.
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Signature of PrincipaVOienl: ~ . ~.~,-
VI. LOBBYIST IDENTIFICATION" _
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01 Produced 10 fLit. 'IX. Ll c ~ 1-1 I h 0 I b 2- \'1 tj V J - ()
Form of Identification
a Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to an~Jsubscribed before me
This ~JNV\ day of ()(~ . 2002.
ignature of Publi Notary - State of Florida
J-./!/r;^) ~IJ{)C/'~HP
Print, stamp or type name of Notary Public
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ULLIAN BEAUCHAMP
NCYr ARY PUBUC Sl'ATE OF FLORIDA
COMMISSION NO. D0109289
MY COMMISSION EXP. APR. 29,2006
FOR CLERK'S USE ONLY
Regi_: [.4mo [] REJECTED DATE: 1.a.J 2:Z,J~
If rejected, state reason: ~' " ,;
Registration fee paid: ~s [ ] No c:;..t' oc-I K1/
[ ] Cash [ ] Check MCR # {21-;2,J.I~_
DATA ENTRY DATE:
1
.2002
ENTERED BY:
1 First RevIsion - 05/17/02