Alan Kahane, First Meridian
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@d.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section.2..481) L
'S OFF ICE
o Check Box if an Amendment
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS ADDRESS: (Number and Street) (City)
505'~'lt~ 3J5'55/.!740
TELEPHONE NUMBER: FAX NUMBER:
D. lI'l'OZ.
(M.I) DATE QUAUFIED AS LOBBYIST
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(State) (Zip Code)
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EMAIL:
1. LOBBYISTRETA1NE~
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NAME OF PRINCIPAl/CUENT:
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BUSINESS ADDRESS: (Number and Street)
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TELEPHONE NUMBER:
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(City)
(State)
33/31
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
FIll out this section if prindpalls a Corporation, Partnership or Trust [SectIon 2-482 (e)]
. 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:
.
11. SPEaFIC LOBBY ISSUE:
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III. CITY AGENaES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: fJlYurJ/1J:;(:JO
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf 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. d...
Signature of LObbYist:~ j!5aL ~
Signature of Principal/Client: /~ '---<.. /' ~ --- ~
VI. LOBBYIST IDE~N:
~roduced 10 fl)L.fP 1<.500 - ODO - S 2 - /l.{z.. - 0
Form of Identification
a Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This \ SI day of N",oJu..doe.{ , 2002.
o IAL NOTARY SEAL
mUAN BEAUCHAMP
NOTARY I'lJIlUC srATE OF FLORIDA
COMMISSION NO. 00109289
MY COMMISSION EXP. A~l?~.
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Signature of Public otary - State of orida
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Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: N' ACCEPTED [] REJECTED
DATE:
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If rejected, state reason:
Reg;""""" ... po.,.!>{Yo< [ ] No '2Sb~
i<t?sh [ ] Check MeR # -k
?AT' ENTRY DATE' iq I ' 2002 ENTEREDBY '1-'
I First Revision - OS/17/02