Steven Marin
-
City or Miami Beach Office of the aty Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerk@d.miami-beach.ft.u5
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4Bl)
t Check Box if an Amendment
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(Last)
) 3 3 Oct
BUSINESS ADDRESS:
S"Ct/
(Number and Street)
5 +eUGVl
(First) (M.I) DATE QUAUFlED AS LOBBYIST
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(City) (State) (Zip Code) Ii
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FAX NUMBER: EMAlL:
NAME OF LOBBYIST:
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TELEPHONE NUMBER:
LOBBYIST RETAINED BY:
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NAME OF PRINOPAl/CUENT:
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Co.~I'XAr, r
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(aty)
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FAX NUMBER: (Optional)
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/33 I) ~w
BUSINESS ADDRESS: (Number and Street)
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TELEPHONE NUMBER:
fL
391 ~ c:
(Zip Code)
(State)
EMAIL: (Optional)
Fill out this section If prindpalls a Corporation, Partnership or Trust [SectIon 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFlOARY: /2'..5 i'7E ~M .A. .s t/~ IE 2-
A~ r~la-:6o /t. /9.4.,c"Z.iJ~
UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTl Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~ S 7'€ f;J ~ 4.. .s IF t4Y'l E Z
Az.. ~ 0 ,fIL /tJd,fZ.lJ6'Uf-
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENClES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
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....
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DIS(:LOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
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B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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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 containecJ in Section 2-482 of the Miami Beach City Code as amendecJ, and all
reporting requirements. ~ '
Signature of Lobbyist: . ____ __
.....--
Signature of Principal/Client: ~~ ~
VI. LOBBYIST IDENTIFICATION: '-.
.
Produced ID
Form of Identification
. Personally Known
VII. SIGJII,A1\\RE"AND STAMP OF ~ARYOR_DEPUTY CLERK:
State of F)orida, County of M'iami~bade \ " . ".
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Registration: ~D
FOR CLERK'S USE ONLY
[ ] REJECTED DATE: ~ 131 (),'<,
/
If rejected, state reason:
Registration fee paid: [ ] Yes [~
[ ] Cash eck MeR #
DATA ENTRY DATE:
I
.2002
ENTERED BY:
I First RevIsion - 05/17/02
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