Portofino Towers CondoCity of Nlaml Beach Office of bhe Ob/Oerk
1700 C~nvenUon Cen~er Drive, Miami Beach, FL 33139
Email: cib/derk~d .mlmnl-beach.fl .us
LOBBYZST REGZSTRATZON FORM
COb/of Miami Beach, Ob/Code Chapter 2, Division 3, Section 2-481)
Q Check Box if an Amendment
140120" Dov(d
NAME OF LOBBYIST:
One. 5.~. 3rd ~¢~oc,
(M.I) DATE QUALI. PIt:u AS LOBBYIST
BUSINESS ADDRESS: (Number and Street) (Ob/)
30~- 5'lq- 24-00 30~- 3"/q- I I0~o
TELEPHONE NUMBER: FAX NUMBER:
(zip Code)
d hat~.~@ Cth2t:O'ia w, ccm ·
LOBBY/ST RETAINED BY:
?OrfOf~ nO Towers
NAME OF PRINCIPAL/CLIENT:
300 5. ?c
,331'39
BUSINESS ADDRESS: (Number and S~'eet) COb/)
305-
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(sram) (Zip Code)
EMAIL:
Fill out this section if principal is a CorporaUon, Partnership or Trust [SecUon 2-482 (c)]
,, NAME OF CHIEF OFFICEI~ PARTNF-~ OR BENEFICIARY:
· LIST ALL PERSONS HOLDING, DIRECTLY. OR INDIRECTLY, A 5% OR MORE OWNERSHIP INI r.y, EST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECiFiC' LOBBY ZSSUE:
issue to be lobbied (Describe in detail):
~.~ i¥ AGENC~IES/IND1VJ[DUALS TO BE LOBBZED:
A) Full Name of Zndlvldual/TIUe B) RelaUonshlp
Zon 50arJ.
IV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYZST COMPENSATZON (DZSCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
B) PR[NC2PAL'S DLSCLOSURE (OF LOBBY[ST COMPENSA'I"ZON):
V. S~GNATURE UNDER OATH:
ON OCTOBER I~r OF EAcH YEAR, EACH LOBBY[ST SHALL SUBMIT TO THE cz ~ ~' CLERK A S~GNED
STATEMENT UNDER OATH, LZST[NG LOBBY/NG EXPENDITURES ZN THE CI'i'Y OF M~AM[ BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
! do solemnly swear th~-al~t~ f/re~/~ng facts are true and correct and that ! have read or am
familiar wi~h ~he provision~~cflon 2-~82 of the Miami Beach City Code as amended, and all
repor~ng requirements,
Signature of LobbYist: /////,f/f t /
Signature of Principal/Client:
LOBBY[ST XDENT/F~CAT~ON:
n Produced ID
Form of Identification
V~. S~GNATUKE AND STM4P OF NOTARY OR DEPUTY CLERKt
State of Florida, County of Hiami-Dade
Sworn J;l~.~nd sub~ribed~fom me
This c~_0 day of ~ IJ.?~, 2003.
[] Personally Known
Signature of Public Notary - State of Flodda
r
RegistratioN: [~cD
Zf ~ecl~, state reason:
Registration fL~e paid: [ ] Yes [ ] NO
DATA ENTRY DATE:
2nd Revision 1/27/03
Pdnt, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
[ ] RE]EL'TED DATE:
[ ]Cash [ ]Ched~ MC.~#
,2003 ENTERED BY:
F:\~ FR\HATL~:fobyists\reglslration 0 3.doc