Jose Rosado/IBEX Meridian
Oty of Miami Beach Office of the Oty Oerk
1700 Convention center OliVe, Miami Beach, FL 33139
Emall: dtyderk@d.mlaml-beaCh.fl.us
LOBBYIST REGISTRATION FORM
(Oty of Miami Beach, CIty COde Chapter 2, Division 3, SectIon i4el)Y C L E R K' S 0 FF ICE
RECEIVED
03 t1.~R 24 AM 8: 39
CI Check Box If an Amendment
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NAME OF LOBBYIST: '(Last) (RISt) (M.I) DATE QUAUFIED AS LOBBYIST
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BUSINESS ADDRESS: (Number and street) (Oty) (State) (Zip Code) , 3' I
331 -,
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINOPAl/CUENT:
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BUSINESS ADDRESS: (Number and Street) (ety) ( te (Zip Codet
3DS -L\4/- ((hCJ, 3DS-&..I4S-IV':>}':;- \FP-D~a.&6))~I,eo-,L
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section If principal Is a COrporation, Partnership or Trust [SectIon 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, O~EFIOARY: \
--1D"S€ 'r=-12.o'S~.I ...Doa.&Al. -.,jA<:Q.c,,\
. LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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U. SPEaFle LOBBY ISSUE:
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Issue to be lobbied (Describe In datall):
10. CITY AGENaES/lNDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/TItle
B) Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FlAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
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B) PRINOPAL'S DI5Q.OSURE (OF LOBBYIST COMPENSATION):_N 0 ~ y
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDrruRES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
nd correct and that I have read or am
e Miami Beach City Code as amended, and all
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Q Produced 10
Form of Identification
i. 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 a \ day of t=;.IN:7M~003.
Registration: ACCEPTED
.-....-, ~
RegIstration fee paid: es [ 0
DATA ENTRY DATE: :t; V Vf
2nd Revision 1/27/03
FOR CLERK'S USE ONLY J /
[ ] REJECTED DATE: '1 2/1 d. "'f
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F:\a.ER\HAn \lObbYIsts\reglstration03.doc