Bob De la Fuente/New FloridaCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emaih cityderk@ci.miami- beach .fi.us
LOBBYZST REGZSTRATZON FORH
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
Check Box if an Amendment
NAME OF LOBBYIST: (Last)
BUSINESS ADDRESS:
TELEPHONE NUMBER:
(First) (M.I) DATE QUALfl-t~b AS LOBBYIST
(Numbe~ and Sl~eet) ' (City) (J (state) ; (Zip-Code)
FAX NUMBER: EMAIL:
L LOBByT_ST RETAZNED BY:
NAIVE OF PRINCIPAL/CLIENT: ¥ ~
BUSINESS ADDRESS: (Number and Street) (City) (State)
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(Zip Code)
EMAZL: (Optional)
Fill out this section if pdndpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
? NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ,
? LIST ALL PERSONS HOLDINg, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
TT. SPECXFIC LOBBY t___q'~tJE:
Iss~dbe in detail):
TiT. %~ t Y AGENC/ES/INDZVZDUALS TO BE LOBBIED:
A) Full Nam of lndividual/'lltle B) Relationship
B) pI~.NCIpAL'~ D[~LOSUEE (OF LOBBYIS'F COMPENSA'TION): '~
V. SIGNATURE UNDER OATN:
ON OCTOBER 1sT OF EACH YEAR~ EACH LOHBY~ST SHALL SuBMl'r TO TH E CITY CLERK A SZGNED
STATEMENT UNDFR OATH~ LZSTTNG LOBBYING EXPENDI'TURE5 IN THE C/TY OF M~AM! BEACH FOR
THE PRECEDZNG CALENDAR YEAR,
I do solemnly swear that all or,he foregoing facCs are mJe and correct and that I have read or am
familiar with the provisions contained in Set, on 2482 of the Miami Beach C_JL-y Code as amended, and all
rePord ncJ requirements.
$ignatureofLobbyis~: j~,~/~e~,/ ~..hr"~/f~. ~.
VI. LOBByT.~5'T ]~DE NTIFI~T~: ~.~
m Produced ID ~ersonally Known
Form of Identification
VII. SIGNATURE AND S'TAHP OF NOTARY OR DEPUTY CLERK:
Stat~ of Florida, CounW ot' ~iami-Dade
Sworn m and subsc~bed befor.e me
-rmv_/*7 _._, 10o .
Signature of Publit~lo~ary- ~a Florida
Print:, ~~ ~~ Public
[frej , · : ' Check Mr.p.# '.,~<, "~-~'/,'~"---
Regism'ation f~e pad: ~ [ ] N~ [ ] Cash t~] , ~ ~.
DATA ENVy DA~:~ ~03 .'I'~D BY~ ~
~ R~i~ ~27/03 F:~~reBl~3'd~