Thomas Telesio/Ocean InvestOty of Miami Beach Office of the Oty Oerk
1700 ConveX/on Center Drive, Miami Beach, FL 33139
Ema[l: dtyderkOd.mlaml-beach.fl.us
LOBBY/ST REGZSTRAT~ON FORM
(Oty of Miami Beach, Ob/Code Chapter 2, Division 3, SecUon 2-481)
a Check Box If an Amendment
~lE OF LOBBYIST: (Last) (erst)
BUS[NESS ADDRESS: (Number and Slreet) (Oty) (State)
TELEPHONE NUMBER: FAX NUMuI~R:
(M.D DATE QUALIFIED AS LOBBY[ST
(Zip Code)
LOBBYZS'r RETAINED BY:
NAME OF PRINCJPALJCLJENT:
BUS[NESS ADDRESS: (Number and Street) (City) (State)
~ FAX NUMBER: (Optional)
TELEPHONE NUMBER:
(ap Code)
EMAZL: (Optional)
Fill out this section If prlndpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFF~CEP~ PARTNER, OR BENEFICIARY:
· LiST ALL pERSONS HOLDZNG, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST lfl SUCH
CORPORATION, PARTNERSHIP OR TRUST:
LOBBY Z~E:
Lcsue to be lobbied (Describe ln detell): /...,A &~.CC~ AY'~--. ;~.~'t~, T~JG /..01~
ITT. q:a,I 'f AGEN(/ES/TNDIV'~DUALS TO BE LOBBZED:
~ .~i,t~FUll~,of Zl~Jbddual/TItJe B) Relationship
ZV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST CONPENSATZON (DZSCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LDBBYISTDI'SCLOSURE: (~""-'~' '""'"' ,,~:::'l:::;:'~.F~.~kr'~C_.~ ~l ~ ~l.,.~,.j....~ O~ _ '
B} PRXNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ //,r'~. ~ ~.~
V. ~GNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEARv EACH LOBBYZST SHALL SUBHZ'r TO THE CTW CLERK A SZGNED
STATEMENT UNDER OATH, LZSTZNG LOBBYZNG EXPENDZTURES IN THE cTrY OF HZAHI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foreg~oing facts are true and correct and that ! have mad or am
familiar with the provisi/~ontained i(~ Section 2-q82 of the Miami Beach ~.~_C_C~/e~s~ended, and ail
mporUng mquirements~ ~ ,~
Signature
Si natum of Prlndpal/Client: / r~ m~,~IA/ / '''~//
g .... ,f / /J' "
VZ. lOBBY[ST IDENTZFZCATZO ; U
;i~Personally Known
o Pmduced ID ~
Form o IdenUficaUon
I/ii. S~$NATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami~Dade
Sworn to and subscribed before me
This Z .day of YtA-'7 ,2003.
~L~~~_~_'~-~. ,,.,._ of Flodda
Signa~u~~c~a~r--~nte
Print, stamp ~
RegiabaUon fee paid: ~U~/r ~[ ] No
2nd Revision [/27/03
] RF_IE~ f~O DATE:
[~J~Cash [ ]chec~
,2003 ENTERED BY
F:\~ FR\HATL\LobbyistsYeglstTationO3.doc