Francisco Ruiz/PR Racing, Inc.
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Oty of Miami Beach Office of the Oty Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@Ci.miami-beach.fl.us
LOBBYIST REGISTRATION FORM
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(Oty of Miami Beach, Oty Code O1apter 2, Division 3, Section 2-481)
!:I Check Box if an Amendment
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NAME OF LOBBYIST: (Last)
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BUSINESS ADDRESS: (Number and Street)
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(First)
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DATE QUAUFIED AS LOBBYIST
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(Zip Code)
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EMAIL:
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(City) (State)
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FAX NUMBER:
I. LOBBYIST RETAINED BY:
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NAMEOFPmNap~OJE .
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BUSINESS ADDRESS: (Number and Street)
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(State)
Fill out this section If principal is a Corporation, Partnership orTl1lst [SectIon 2-482 (e)]
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NAME OF CHIE~ OFFICER, PARlNER, OR BENEFIClARY:
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UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARlNERSHIP OR TRUST: ()
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SPEaFle LOBBY ISSUE:
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Issue to be lobbi (
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IlL CTY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/TltIe B) Relationship
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FLATRATEOR OTHER):
A) LOBBYIST DISCLOSURE:
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B) PRINOPAl'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code ChaDter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
2)
purs:nt t~ Ordi~nC~ No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division 5
ther f En itled " m aian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
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: _.~ J/
VI. LOBBYIST IDENTIFICAnON:
~ProducedID FI",,\~~ D,/<Jt.,; r\Le",-'~
Form of Identification
Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Aorida, County of Miami-Dade
Sworn to and subscribed before me
This :2 (;) dayof}Jo \J . .2003.
MAURICIO ANDA
Notary Public, Slale of Florida
My comm. expo Mar. 13,2007
Comm. No. DD 193127
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Signature of Public Notary - State of Florida
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Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: -l<lACCEPTED
If rejected, state reason:
Registration fee paid:)<fYes [ ] No
DATA ENTRY DATE: ill~'
2nd Revision 3/18/03
[ ] REJECTED
DATE:
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[ ] Cash' [ ] Check MaR #
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. 2003 ENTERED BY: )
F: \ LER\HATI.\LobbYlsts\reglstrationa03.doc