Copley Plaza, Inc.City of Miami Beach Office of the City CJerk
1700 Convention Center Ddve, Miami Beach, FL 33139
Emaih cityderk@ci.mia mi-beach.fi.us
LOBBYt~T REGI~I'RATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4B1)
Check Box if an Amendment
NAME OF LOBBYIST: (Last) (First)
BUSINESS ADDRESS: (Number and Street) (City)
TELEPHONE NUMBER: FAX NUMBER:
(M.I) DATE QUALIFIED AS LOBBYIST
(State) (Zip Code)
EM/~L:
LOBBYIST RETAZNED BY:
NAME OF PRINCIPaL/CLIENT:
BUSINESS ADDRESS:
TELEPHONE NUMBER:
(Number and Street)
(City) (State) (Zip Code)
FAX NUMBER: (Optional) EMAIL: (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: ~)O~l~ s-~(xkAo~J~ 13~,,?~5~Z-
SPEC'tFZC LOBBY ZSSUE:
Issue to be lobbied (Describe in detail)'."
CZTY AGENCZESI[NDZVZDUALS TO BE LOBB[ED:
A) Full Name of [ndivlduallTitle B) Relationship
Pursuant to Ordinance No. 2003-3393 Amendlna Miami Beach ClW Code Chaoter 2. ArtiCle V~I, Division S
Thereof Entitled"Camaalan Finance Reform" Via The Addrdon Of Code Section 2-488 Entitled "Prohibited
Camnaian Contributions By Lobbyists On Procuremen~ Issues";
Pursuant to Ordinance No. 2003-33gS Amendina Hiami Beach Cl'w Code Chaoter 2, Article Vii Division 5
thereof EntlL'led ~Camnalan Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoalan Contributions By Lobbyists On Reap Estate Development Issues":
~ you Iobb~fno on a ~ndln~ am~llc3Uon ~ a Davalom~e~t A~re~ment ~ ~ ~ m'
ON OCT'CIGER :l.m OF EACH YEAR, EACH ~ SHALL SUBI4ZT TO Ti. IE ~m Y CLERK A SZGNED
STATEMENT UNDER OATH, L.ZST~NG L(X3BYZNG EXPENDI'TURES ZH THE ~J.i ~' OF HZAMI BEACH FOP,
TIlE PRECEDING CALENDAR YEAR.
! do solemnly swear that all of the foreg,etng facts are true and correct and that I have read or am
familiar with the provisions contained j~e~tton :~82 of the Mianl~Jeach City Code as amended, and all
reporUng requirements. / ~ ( / ~ "~
Signature of Lobbyist: / / // //// J ~ ~ ~
'~$1gnature of Principal/aient: ~/~'%,~_~_ _~~
Form of ]cbntlflcaUon
State of Flodda, County of Miaml-Dade
Sworn to and subscribe~l be~o,r~ me
This /,.g'~'~ day of~ 2003,
lOFFICIAL NOTARY SEAL
LtLLIAN BEAUCHAMP
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. DDI0928g
MY COMMISSION EXP. APR. 29,200~
f Pul:~ I~otary - State of ¢lorida
Print, stamp or type narr~ of Notary Public
Registration:
If rejected, state reason:
Regis~-aUon fee paid: ~ [ ] No
/
2nd Re'as~on 3/X8/03
· 2003 ENTERED BY: ~ -- --