Mr. Smillow
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City of Miami Beach Office of the City aerk
1700 Convention Center DrIve, Miami Beach, FL 33139
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Email: dtyclerk@cl.miaml-beach.n.U5 (\ ; "J,: ',," L.-'
LOBBYIST REGISTRAll0N FORM U,-"" ,.; r. ~ CE.
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(Oty of Miami Beach, Oty Code Chapter 2, Division 3, Section 2.1.4S11 , L.L"
a Check Box If an Amendment
Co I -Ff1tf.+M fie ~~pQ Nov. l,U"I'Z
NAME OF LOBBYIST: (Last) (First) (M.I) DATE QUAUFIED AS LOBBYIST
(1(( l<~ (p~&e #- b(.D ~ ~~~., ~L ~~{'""
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
(~o>) ~69~~-11" (~qS) B~/-67J.fA ~fllQIVJoCC!P~
TELEPHONE NUMBER: FAX NUMBER: EMAIL: CJ:2."t
I. LOBBYIST RETAINED BY:
Wlr. 5~ll ~W
NAME OF PRINOPAl/CUENT:
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BUSINESS ADDRESS: (Number and Street)
(~c7r) ~(-4",3+
TELEPHONE NUMBER:
,/V{(JlfI..;
(aty)
~,PUil.t f<-
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(State)
~ ~ (1-0
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If prIndpalls a Corporation, Partnership or Trust [Section 2-482 (c))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFlCARY:
. UST All PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
D. SPEaFle LOBBY ISSUE:
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Issue to be lobbied (Desaibe In detail):
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III. cnv AGENaES(INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual('ntle B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOROTHER)
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A) LOBBYIST DISCLOSURE: I
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B) PRlNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~
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.
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 contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
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Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
a Produced ID
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Form of Identification
a 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 I~ day of YJ~ 2002.
~ a\. Lltiam R H8tlIeId
. ~ . My Commiaaion DDl102Q20
~.."l Expires Febru8ry 18, 2005
SI nature of Public Nota State of Florida
Li 1/QflJ) /2. ~'JcI
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration:
[~CCEPTED
[ ] REJECTED
DATE:
It - ( -()'2-
If rejected, state reason: /
Registration fee paid: p1;tes [ ] No
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DATA ENTRY DATE: I ( , I 2002 ENTERED BY:. .. f ~
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I First Revision - 05/17/02