HomeMy WebLinkAboutSy Chadroff/ Philips So Beach 1700 Convention Center Drive, Miami Beach, FL 33139
Ema[l: dtyclerk~d.mlaml-beach.fl.us
LOBBYIST REGISTRATION FORM 03 JlJN ~ FO ~ 3: OB
Q Check Box If an Amendment
N~M~: OF LOBBYIST: (Last) (First)
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BUSINESS ADDRESS: (Number and Street) (~ty)
TELEPHONE NUMBER:
t (M.I) DATE QUALu-L~:u AS LOBBYIST
(State) (rap Code)
lAX NUMBER: EMAIL:
I, LOBBYIST RETAINED BY: ,j
NAME OF P~P~E~:
T~ F~ONE NUMBER:
(aty) (state)
FAX NUMBER: (Optional)
(Z~p Code)
EMAIL: (Op~onaI)
Fill out'chi; section If principal Is a CorporaUon, Partnership or Trust [SecUon 2-482 (c)]
~IAME OF CHLEF OFFICER, PARTNER, OR BENEFICIARY:
· ITST~LLPERSONSHOLDI~G, DIRECTLY OR IN , ~'~ , , ~,/,,~, _ _
SPECiFiC LOBBY L~,E: ~ .
Issue Io be Iobbiecl (Describe In del:all):
II/. ~ AGENCIES/INDIViDUALS TO BE lOBBIED:
A) Full Name of Indhadual/TIUe B) Rd~donship
DZSCLOSURE OF TERHS AND AMOUNTS OF LOBBYZST COHPENSATZON (DZSCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
V. S~GNATURE UNDER OATH:
ON OCTOBER IsT OF EAcH YEAR, EACH LOBBYZST SHALL SUBHZT TO THE uz, '~ CLERK A SZGNED
STATEMENT UNDER OATH, IAblzNG LOBBYING EXPENDZTURES IN THE CZTY OF HZAHI BEACH FOR
THE PRECEDING CALENDAR YEAR.
! c~o solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions con.,te~ in S~ct~on 2-48,~ of the Mi~am~i~3each City Code as amended, and all
reportJng requirements. / j~,~//~/ / l ~.~
Signature of LobbYist: Y~--~-! ~/,C~L/L//~ ~ --
LOBBYIST IDENTZI=ZCATZON:
onally Known
Produced ID
Form of IdenUficaUon
~ZGNATURE AND STAMP OF NOTARY OR I~ElatnY CLERK:
Sworn to and subscribed before me
This I.(~ day of "~,~.~_. , 2003.
i(~,(~o[~.~} ~, c.~.., ~i ~..~,o~ I Sign~--tu~f ~'uBlic I~ta~7~~of Florida
PrinL, stamp or b/pe name of Notaw Public
If rejected, state reason:
Regi~baUon fee paid: ~Yes [ ] No
DATA ENTRY DATE: ~/
i
7.nd Revision L/27/03
FOR CLERK'S USE ONLY
[ ]RE]ECTED DATE: