Water Fantaseas
.j
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atv d ~11leIlch 0fIlce d the CIty CIer1<
1700 CorMIntIon c:en. 0rMI, MI8mIIlellch, R. 33139
EITllIiI: c:ItydeI1<CPd.~.ft.US
LOBBYIST REGISTRATION FORM
-
(CIty d MiIlmlIlellch, CIty Code 0Iaptw 2, DMsIon 3, SettIon 2-41)
III Check Box If en Am.....nt
~AL.~
NAME OF LOBBYIST: (Last)
~lD3 b"W ~ &r *204-&
BUSINESS ADDRESS: (Number and street)
306- 44l- 12..1-~
TELEPHONE NUf4lER:
A~
(First) (M.I) DAlE QUAUFIED f>S LOBBYIST
MUtMI FL. 33136
(atv) (State) (Zip Code)
.2JJr;- 441-- :2L{'6~ t\xlIS(fo.@WKls-baKcr6\ .
FAX NUr4lER: EMAIL: CO 1V1
-y
L LOBBYIST RfTAINm BY:
W ~tefL FantlJH'as
NAME OF PRJNCIPAl/CUENT:
?:il1:1 N l- IlONLP ~ N'. M-l(lfUl ~aO-1
BUSINESS ADDRESS: (Number and street) (City)
~s- - q33- 4t).-'1Q
TELEPHONE NUfeER: FAX NUMBER: (0pli0naI)
FL
(State)
33l{pO
(Zip Code)
EMAIL: (Optional)
F11 out tIllllec:t1an If prlRdpel II /' ~. ~ItMnIIIP or 1'rud [SecIiDn 2-482 (e)]
'- -
1 NAME OF CHIEF 0FFl(5, PARTNER, OR. BENEFICIARY:
1 Jr~~!m~~~~~Y'A 5% OR.~ eJ.'mERSHIPItmRESTIN SOCH
CORPORATION, PARTIlERSHIP OR. TRUST:
a,rtlltL-DD 12-~
Do SPECIFIC LOBBY ISSU!:
'--tDbe~~~~~ b~
m. CITY AGENCIES/INDIVIDUALS TO IE ~~
A) Full ... of 1IIdIvIIIHI/TItIe
B) ReIdIonIIIIp
/rL-L
. IV. DlSO..O!RlRE OF tERMS AND AMOUNTS OF LOBBYIST CGRNSA110N (DJSa.OSE WHETItER HOURLY,
RAT RAT!' OR OTHER):
~
A) LOBBYIST DI'iCl ()C:IIRE:
i.3.QO I ttDWZ-
B) PRINCIPALS DISClOSURE (OF LOBBYIST r::.oMPfHSATIC'liO:_1J. J 00 / I-i~
,
v. SIGNATURI! U'lJDI!R OAtH:
ON OCTOBER lIT OF EACH YEAR, EACH LOB8YIST 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.
II! Produced 10
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOII8YIST .......ur&CAnON:
Form of Identification
II! Personally Known
YD. SIGNA1VRE AND STAW OF NOTARY OR DEPUTY aDK:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This .., day of:TClnua ft.". 200t.3 e IJ ;::. I
d-oL" ---,.)
Signature of Public Notary - State Of Florida
~ ::J v'alde~
Print, stamp or type name of Notary Public
o~ B.J. VAlDES
,001 MY COMMISSION' DO 090119
EXPIRES: February 7, 2006
BondedThIU_ryPubllcUnderwrittrs
/' FOR CLERK'S USE ONLY
Registration: [l-rACCEPTED [] REJECTED DATE:
If re~, state reason' -----
Registration fee paid: [~es [ ] ~~
[ ] cash [ TOleCk
/-f>{)-3
DATA ENTRY DATE:
1
MCR#
- ENTERED BY~ ..->
1 First RevIsIon - 05/17/02