Higima Castro/Vertical ParkingOb/of Miami Beach Office of the Ob/Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emalh cib/clerk~d.mlami-beaCh.fl.us
LOBBY/ST REGISTRATJ:ON FORM
(Ob/of Miami Beach, Ob/Code Chapter 2, Division 3, SecUon 2-481)
Q Check Box if an Amendment
NAME OF LOBBYIST: (Last)
BUSINESS ADDRESS: (Number and Street)
(Ob/) (Sia~e) (Zip Code)
·
/
TELEPHONE NUMBER:
FAX NUMBER:
LOBBYIST. RET'A/NED BY:
NAME OF PR/NC/PAL/CL/ENT:
BUSINESS ADDRESS:
(Zip Code)
(Number and Street) (Oty) (Ska~)
FAX NUMBER: (Optional)
EIVLML: (Op~onal)
Fill out this section if pdncipal is a CorporaUon, Partnership or Trust [Section 2-482 (c)]
NAME OF O-lIEF OFFZCER, PARTNER, OR BENEF[CLARY:
LIST ALL PERSONS HOLDING, DIRECTLY OR INDIP. ECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORA'I'JON, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY XSSUE:
L~sue to be Iobt~ed (Describe in detail):
CZTY AGENCXES/I'NDIVZDUALS TO BE LOBBIED:
A) Full Name of Zndmvidual/'riUe
FLAT RATE OR OTHER):
B) PmN~PAL~ D~
DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATZON (D][SCLOSE WHETHER HOURLY,
V. S~GNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR, EACH LOBBY/ST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, L~ST~NG LOBBY/NG EXPENDI'I'URES IN THE CI'TY OF M[AMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
! do solemnly swear that all of the foregoing facts are true and correct and that ! 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.--~/. .
Signature of LobbYist: ~__~'~7~,~ ~ y
Signature of Prindpal/Client ~~. ' ~~
VZ. LOBBYIST XDENTZFZCATZON:
~/ProducedTD (_.~3~'-_~;20U- /(,'71 (_..~/e//~r/ [] Personally Known
Form of [denfification
· V~/. SZGNATURE AND ~rAMP OF NOTARY OR DEPUTY CLERK:
State of Flodda, County of Miami-Dade
Sworn to and subscribed before me
This ~Z'~/-~-- day of ._-~-?"~m~-,~.. 2003.
Signature of Public Nb~ary - State _~j~ida~m
Pflnt, stamp or ~/pe name of Notary Public
Reglsl~Uo~ fee paid: [ lyes [ ] No
DATA E~TRY DATE: ~-~j*Z.~ ]
2nd Revision ~/27/03
FOR CLERK'S USE ONLY ~/~ ~ ~ /~ ~
[ ] RF-]E~D DATE:~ ~)
[ ]Cash [ ]Check
,2003 ENTERED BY: ,~/~
F:\CLER~lATL\LobbylslsYeglslration03.doc