Emilio Navarro/Vertical ParkingOb/of Miami Beach Office of the Ob/Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: db/dedcOd.mtaml4~.ach .fi.us
LOBBYT. ST REGTSTRAT~ON FORM
(Oty of Miami Beach, Ob/Code Chapter 2, Division 3, Section 2-,181)
c~ CI1~ck Box if an Amendment
NAME bF LOBBYT. S'F: (Last) _ (first)
BUS[NESS ADDRESS: (Number and S~e~) (ab/)
TELEPHONE NUMBER: FAX NUMBER:
DATE QUALI~e.u AS LOBBYIST
(sram)
(Zip Code)
EMA~L:/
NAME OF PR[NCZPAL/CL[ENT: ~-,Y..~ ~
BUS[NESS ~D~: (N~r and ~) (~) ~(S~) ~P ~)
~PHONE NUMBS: F~ NUMBS: (~E~a;) E~L: (Op~o~al)
Fill out this section if pHndpal is a CorporaUon, Partnership or Trust [$ecUon 2-482 (c)]
· NAME OF Orl]EF OFFZCER, PAR'I'~ER, OR BENEF[C~I~,RY:
· I/ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE O/WNERSHIP INlr. KEST IN SUCH
CORPORATION, PARTNERS_HIP OR TRUST: .~,') / /
Issue tn be lobbied (Describe in detail):
Zrt. ~ i ( AGENCZES/ZND1VZDUALS TO BE LOBBTED:
FLAT RATE OR OTHER):
B) P~N~AL~ D~OSU~ (OF LOB~ ~M~ON):
D~SCLOSURE OF TERMS AND AMOUNTS OF LOBBY"-.ST COMPENSATION (DI'SCLOSE WHETHER HOURLY,
V. SZGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBY/ST SHALL SUBHIT TO THE ~ I ~' CLERK A SIGNED
STATEMENT UNDER OATH, LZSTiNG LOBBY/NG EXPENDITURES I'N THE CI'TY OF M/AH1' BEACH FOR
THE PRECEDI'NG CALENDAR YEAR.
! do solemnly swear that all of the ~fegoing facts are true and correct and that ! have read or am
familiar with the provisions contain~n 2-482 of the Hlami Beach City Code as amended, and all
reporting requirements.
Signature of LobbYist:
Signatum of Principal/Client: ~
VL .LOBBYXST XDENI'~F'~CAT~ON: ~ ~ .
'~Pmduced ID /1'///~"2/~' '~ [] Personally Known
Form of Identification
ViZ. S~GNATURE AND STAHP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami:Dade
Sworn to and subscribed before me
This :~/ day of /9~t~,~ ~ . 2003.
Regl~baUon:
If rejected, state reason:
Reg~baUon fee paid: LllYes [ ] NO
DATA EN'I~Y DATE: ~'~/,~ I
2nd Revision ~/27/03
Signature of Public Notary - State of Florida
~,~ ~ Uliam R Haft'mid
~ ~.~ .~ My Commission DO002020
Print, stamp or typ(?~'at~c~ffl~:/t~F ~
FOR ctr~K's~ USE ONLY ~_~/~ ~.~
[ ] REJECTED D_.~TE:
F:~R~~I~fl~03.~