David Haber/Portofino Towers RECEIVED
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL331~3 JU~ 30 P~ I,' 08
Emaih cityclerk@ci.miami-beach.fl.us
LOBBYIST REGZSTRATION FORM CITY C
.LEt~ S OFFICE
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
a Check Box if an Amendment
Hobcr, . t vid
TELEPHONE NUMBER: FAX NUMBER: EMAIL: C_.~.~
I. LOBBYIST R~, AINED BY: ~
NAME OF PRINCIP~LIENT',
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
TELEPH~)NE NUMBER: FAX NUMBER: (Optional) EMA]L: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III, CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
tV. DISCLOSURE OF TERMS AND AHOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOLIRL Y,
FLAT RAT£ OR OTHER.):.
V. SIGNATURE UNDER OATH:
ON OCTOBER Ist OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE cI-rY OF MIAMI BEACH FOR
I do solemnly swear that all of the fore e an~cLcorrect and that I have read.oc~;n~
familiar with the provisions contained i/~ ~;~;~E~'~e Miami Beach City Code as a~,~'r~'~, ~ all
r.o ,n r.
Signature of Lobbyist:
Signature of Prindpal/Client:
VI,
LOBBYIST IDENTIFICATION:
Produced ID
Form of Tdentification
)f~/Personally Known
SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ _day of r')~O- ~O~,~r 2003.
.~ Nm'~t lelss
Signature of Pubhc Notary - State ~f Flodaa
Print, stamp or type name of Notary Public
Regisb'ation: A~CCEPTED
If rejected, state reason:
Registxafion fee paid: [~j,,'/'es [ ] No
DATA ENTRY DATE:
2nd Revision 1/27/03
[ ] RE3ECTED DATE:
[ ] Cash [ t~heck HC~ ,
,2003 ENTERED BY:,~/..~ ~
F:\~HATL\Lobbyists\registration03.doc