Sy Eisenberg - Dr. Schnur
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-
aty of MIami Beach Office of the aty aerie
1700 Convention Center Or1ve, Miami Beach. Fl 33139
Emall: dtyderk@d.mlaml-beach.ft.US
LOBBYIST REGISTRATION FORM
(aty of Miami Beach, aty COde O1apter 2, Division 3, SectIon 2-481)
a Check Box If an Amendment
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NAME OF LOBBYIST: (Last) (First)
/6hS $#-W//~#/JPE" 4;f'/3
BUSINESS ADDRESS: (Number and Street) (aM
30,) S-3;;Z/ 101
FAX NUMBER:
t5.
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(M.I)
//
(State)
DATE QUAUFIED AS LOBBYIST
3.3/ of t?
(Zip cede)'
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TElEPHONE NUMBER:
---
EMAlL:
I. LOBBYIST RETAINED BY:
j)~ ~7R/;;{/ SC/YR (./ ,e:
NAME OF PRINOPAL/WENT:
p/
(State)
-:l~ IJ2ZJ
(ZIp Code)
EMAIL: (Optional)
Fill out this section If principal Is a COrporation, Partnership or Trust [SectIon 2-482 (c)]
. NAME OF CHIEF OFFICER, PARlNER, OR BENEFIOARY:
. usr ALl PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
':).."0, \~_J~"",""'\\ cfVI-\Q
,
II. SPEaFle LOBBY ISSUE:
Issue to be lobbied (Describe In detail):
III, CITY AGENCIES/INDMDUAlS To BE LOBBIED:
B) RelatIonship
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IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FlAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
A/,1 4I'~
B) PRINCIPAL'S DISQ.OSURE (OF LOBBYlsr COMPENSATION): /Y' 4:::J N'.~
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all
reporting requirements,
Signature of lobbyIst:
Signature of Principal/Client:
VI. LOBBYIST IDENTIfICATION:
~ersonallY Known
Cl Produced ID
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and SUbSCribej before me
This ,;JI) ~ day of ( .J.;-"f~ , 2003.
~~~41~~.
SI ature of bUc Notary - State of Florida
!-t"/hON bu~~
Print, stamp or type name of otary Public
OfFICIAL NOTARY SEAL
LILLIAN BEAUCHAMP
NOJ'ARY PUBLIC srATE OF FLORIDA
COMMISSION NO. D0109289
MY COMMISSION EXP. APR. 29,2006
ReglstraUon: ~
If rejected, state reason: /'
Registration fee paid: [ :t'fes [ ] No
DATA ENTRY DATE: J.Qj-z..o
2nd Revision 1{27/03
FOR CLERK'S USE ONLY
[ .] REJECTED DATE: fa /z,1J Jd3
I .
[ lCash (~ MCJt#;?(, vt:rf
.2003 ENTERED BY: ~.
F:\CLER\HAn \LobbyIsls\reglstraUon03.doc