1600 Euclid Association Inc.
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City of Miami Beach Office of the City Cieri< \ ' ..
1700 Convention Center DrIve, Miami Beach, FL 33139 p". ..,?
Email: dtyclerl<@ci.miaml-beach.n.U5 WI" . I U' {. ,-
LOBBYISTREGISTRA110N FORM, Jt... ..,~'.('S oH \Ct.
(City of Miami Beach, City Code Chapter 2, Division 3, ~Qn,2""lht ,\ \ \
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CJ Check Box If an Amendment
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NAME OF OBBVIST: (Last)
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BUSINESS ADDRESS: (Number and Street)
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TELEPHONE NUMBER: FAX NUMBER:
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(First)
(M.I)
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(State)
DATE QUAUFIED AS LOBBVIST
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(Zip Code)
3 77 4-S'?:/1
EMAIL:
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(City)
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~!>BBYIST RETAINED BY:
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NAME OF PR1NClPAL/CUENT:
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BUSINESS ADDRESS:
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TELEPHONE NUMBER:
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(Number and Street) (City)
534 lP{~
FAX NUMBER: (Optional)
Ml AM'
(State)
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FL S3(~L
(Zip Code)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust (SectIon 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICARV:
/
. UST All PERSONS HOLDING, DIRECf1.V OR INDIRECf1.V, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEaFIC LOBBY ISSUE:
'2.o^-,tNEr H~Atq~
Issue to be lobbied (Describe in detail):
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III. CITY AGENaES/lNDMDUALS TO BE LOBBIED:
, A) Full Name of Indlvldual/ntle B) RelationshIp
ZOMrlWc; If&: A ar N C-z
.
.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
Fl.ATRATE OR OTHER;'
A) LOBBYIST DISCLOSURE:
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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, UmNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
Signature of Lobbyist:
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L /;;. L/-II" - .
orm of Identification
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I do solemnly swear that all of th
familiar with the provisio ined i
reporting require
Signature of Principal/Client:
VI.
1:1 Produced ID
1:1 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 ,-;j- day of n~..) 2002.
"...;'\. Uliam R H8\fieId
tJ' . My Commission DDOO2020
'\'}';.J Expir. February 18,2005
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Srgn, ture of Public No - State of Florida
6 J;'M1 ,e "-hI{ d d .. .
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY /_
Registration: ~~ [] REJEcrED DATE: 1[. /.- O?
If rejected, state reason: ~
Registration fee paid: ~ [ ] No 1. e- i4~ 0
MCash [ ] Check MeR # ~ ~ J b
pATA ENTRY DATE: Jlj I I Od--'. 2002 ENTERED BY /. ~
I FIrst Revision - 05/17/02