Armando Gutierrez
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aty of Miami Beach Office of the aty Oerk
1700 COnvention Center Drive, Miami Beach, FL 33139
Emall: dtyderk@d.miaml.beach.f1.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
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NAME OF LOBBYIST: (Last)
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BUSINESS ADDRESS: (Number and Street) (City)
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F NUMBER:
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(M.I) DATE UAUFIED AS LOBBYIST
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(State) , (Zip Code)
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCPAl/CUENT:
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BUSINESS ADDRESS: (Number and Street)
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(Zip Code)
EMAIL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [SectIon 2-482 (e)l
NAME OF CHIEF OffiCER PARTNER OR BENEFICIARY: .E S'f'E~ I?-tJ/ :5 v I9-fC Ii ?-
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LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: JE S III. /!11'f1J S l/M. /::--z-
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II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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III. CITY AGENCES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/ntle
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISClOSURE:
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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v. SIGNATURE UNDER OATH:
ON OCTOBER lIT 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.
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
"",Di" with the """,'00"' ro,,",,"'" '"/1""" h2 of the Mom1 Bea'" aty Code '" .meoded, ",d .11
reporting requirements. (JJ
Signature of Lobbyist: '
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICAnON:
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V"Produced 10
Form of Identification ~ ~
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. 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 ~l)bh day of r,JVlpl1-' 20<9-
f Florida
Public
FOR CLERK'S USE ONLY
Registration: ~ ACCEPTED [] REJECTED
If rejected, state reason:
Registration fee paid:
DATE:
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DATA ENTRY DATE:
1
1 First Revision - 05/17/02