Anastasia Yecke/Sarmiento Ad
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oty of Miami Beach Office of the Oty Oerk
1700 ConventJon center DriVe, Miami Bead'l, FL 33139
Emall: dtyderk@d.mlaml-beach.ft.us
LOBBYIST REGISTRAnON FORM
(Oty of Miami Beach, Oty COde Chapter 2, Division 3, SectIon 2-481)
o Check Box If an Amendment
~~c-tL. eras-tCl$~ C. 1/:1-1 J03
NAME OF LOBBYIST: (Last) (Rrst) (M.I) DATE QUAUFIED AS LOBBYIST
++l~cto.& S-lt. G:oa / ~/1M( a ~?J '?l
BUSlNESSADDRESS: _ (Number and sikt) I (aty) " (State) (Zip COde) .
(;D:~ry'OO -"1-:E5 4d.)~mJ D-'f~ct.e-cfiJ/~'(Y)I~. (let
TELEPHONE NUMBER: FAX~UMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAMEO~~~~~'io ftdJffJ(~ 8 [QV p
BUSlNESSji~!n~L) s~(aty&rv! (Yl,\q~ I 1==-L- ~~~ ~L
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FAX UMBER: (OptJonal) EMAIL: (Op~al) :xJ (')
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Fill out this section if principal is a Corporation, Partnership or Trust [SectIon 2-482 (c)] 0 N rn
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· NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: EdvcucLo T e,f\ ()J(\()~ ~
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. UST AlL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
LOJ-OJro Aioo - \0'70
D. SPECFlC LOBBY ISSUE:
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In. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/ntle
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER): Ir. ' '\
A) LOBBYIST DISQ.OSURE: (,Zf CWO C~~
B) PRINOPAL'S DISClOSURE (OF LOBBYIST COMPENSATION):
v. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 co~~ained in 5 'on 2-482 of the Miami Beach City Code as amended, and all
reporting requirements. // ._'
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Signature of Lobbyist:
Signature of Prlndpal/Client:
VI. LOBBYIST IDENTIFICATION:
/ Produced ID fl> U\- ~ 200:- Do?r k, - -;>q :)- 0 0 Personally Known
Form of I entification T _ NOfARYSEAL
. . ULUAN BEAUCHAMP
VII. . SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: NorAKYPlJBUcsrATE OFFLORIOA .
COMMISSION NO. 00109289
MY COMMISSION EXP. APR. 29~
State of Florida, County of Miami-Dade
Sworn to and SUbscri~,re me
This d1-tt., day of .. . 2003.
FOR CLERK'S USE ONLY
Registration: ~ACCEPTED
[ ] REJECTED
DATE:
4, '- ~ ~ ~-c ?
If rejected, state reason:
RegIstraUon fee pald:;0ves [ ) No
DATA ENTRY DATE: 1 2YI {O~
2nd Revision 1/27/03
[ ] Cash [ ] Check
. 2003 ENTERED BY: