Scott E. Mitchell/WCI Comm.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@d.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
RECEiVED
03 OCT 2 I PH I: S9
CITY ClERi\'S OFF ICE
lD
-
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o Check Box if an Amendment
~/ldLht n SCOtt-
NAME OF LOBBYIST: (Last) (First)
'2 S, B."seCt Yle B"I& =if3YOO
BUSINESS ADDRESS: (Number and Street) (City)
DC:; 3/~ ~O
TELEPHONE NUMBER:
~
(M.!) DATE QUAUFIED AS LOBBYIST
aWl' f-L
(State)
610 $.
I. LOBBwcrNED[;,mMun fA I he
NAME OF PRINCIPAL/CLIENT: ~
/ '3450 LV SUf}(ise BlveR. 4ft{ZO Sunn~e ff.- 3~723
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
15Lf~t.f0 7-Z27 q.5J/~Lf(P'2Zq2-
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
.
NAME OF CHIEF OFFjJi!r:7' Olf:f?:;;~
UST ALL PERSONS HOLDING, DIREffi Y OR INDIREffi Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARlNERSHIP OR 1RUST:
.
II.
3<60 I
6f(fYl5
MrCclM r < &a.c ~
IU. OTY AGENCES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
I h 4> I"V14.. j.. j)A f) t:7 1'1 e
Jf-
'lV. DISCLOSURE OF TERMS AND AHOUNTS OF LOBBYIST COHPENSA nON (DISCLOSE WHETHER HOURL Y,
FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: j 2.. 75 /l (!) u ( (o-
B) PRlNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
1)
2)
?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
ing facts are true and correct and that I have read or am
Section 2-482 of the Miami Beach City Code as amended, and all
I do solemnly swear that all of the or
familiar with the provisions contain d i
reporting requirements.
Signature of Lobbyist:
Signature of PrincipaVClient:
VI. LO.BYIST IDENTIFJCAnON: C (' I 1 J i _ , (
/' ~LtH32~/~.s--~~~ "Uolj-O-SCOII c. ~\S nlll:~\
tY Produced 10 ~ 1.\:2-3- 'l> ? - I/'" "'2?- 0 0 Personally Known
Form of Identification V\<::m, Ht\nve....L.. ~l.\ IlestA-..s.
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ \ 51 day of OCTD b~. 2003.
OFFICIAL NOTARY SEAL
LILLIAN BEAUCHAMP
NOTARY PUBLIC Sf ATE OF FLORIDA
COMMISSION NO, 00109289
MY COMMISSION EXP, An,29,2006
FOR CLERK'S USE ONLY
Registration: )cg ACCEPTED
If rejected, state reason:
Registration fee paid:l<rves [ ] No
DATA ENTRY DATE: JQ.j 1.z.
2nd Revision 3/18/03
] REJECTED
DATE:
. W~'l.\- O~
[ ] Cash .b(1' Check
. 2003 ENTERED BY: