Lana Bernstein/Ocean Drive Mag
to
-
-
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@d.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
(aty of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
[J Check Box if an Amendment
in)
(Last)
F.
(M.!) DATE QUAUAED AS L08BYIST
. &ern&'
NAME OF LOB 1ST:
30S) 53J- - 25t\"\'"
LEPHONE NUMBER:
(Zip Code)
\cine!@OCr{:tt1J r lVt'(O~
EMAIL:
I. LOBBYIST RETAINED BY:
CX-ec\ Y1 Dn Vr", (V\05 Cl z i ne.,
NAME OF PRINCIPAL/CUENT:
-104 ~'\JlA&\'\\Y\~1Oi(\ AVf Sln-\e &s;o HiQIl'li ~Chl fL
BUSINESS ADDRESS: (Number and Street) (aty) (State)
. ) S?,)-2Stt4 3CSJ 53')'-43<i;'<&'
LEPHONE NUMBER: FAX NUMBER: (Optional)
3sl3C1
(Zip Code)
EMAlL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (e)]
NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY:
UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Ovrv1QVYlifJl
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Relationship
MiamLJ2e
NO (e\O\ ,\-," cnSh lto
IV. Ul;:K..LU3UKC ur IICKPI:t ""'U R.PlUUn 13 ur LUDDT 131 \"UPlt"CI":IJi\11Urt \.UC"..L~C ""CI nCK nVUKL',
FLATRATEOR OTHER): file
A) LOBBYIST DlSUOSURE: _
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
c
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
nt or services or on a resent
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST 5HALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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:
VI. LOBBYIST IDENTlFICA N: . 1505 d.. '5:1 (p ~
IlY'" Produced ID tfa...}ilWfUliWJ'
Form of Irentification
10
Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miam~Dade
Sworn tq ,qnd subscribed before me
This 11"-'> day of~)61{UIAhe.v': 2003.
lorida
'Bc-v~o... 'F~
Print, stamp or type name of Notary Public
Registration: ~EPTED
FOR CLERK'S USE ONLY I
[ ] REJECTED DATE: II I Ljo <)
f
DATA ENTRY DATE:
[ ] Cash [
2003
If rejected, state reason:
Registration fee paid: [
2nd Revision 3/18/03