Steven Marin/ZyscovichCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emaih cityderkC~ci.mi~mi -beach.fi.us
LOBBYZST REGZSTRATZON FORM
(City of Miami Beach, City Cede Chapter 2, Division 3, Section 2-481)
Q Check Box if an Amendment
NAME OF LOBBY[ST: (Last)
/ 33o 5w
BUSINESS ADDRESS: (Number and Street)
TELEPHONE NUMBER:
RECEIVED
04 FEB -3 PH !: 3h
CiTY ~:LERK OFFICE
(First)
(City)
FAX NUMBER:
(M.I) DATE QUALIFIED AS LOBBYIST
(State) (Zip Code)
EMIL:
I. LOBBYZST RETAZNED BY:
NAME OF ~RINCIPAL/CIIENT:
BUSINESS ADDRESS: (NumSe~ and Street)
TELEPHONE NUMBER:
(City) (State) (Zip Cede)
FAX NUMBER: (Optional)
EMA[L: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAMEOFCHIEFOFFICER, P,ARTNER, ORBENEF']CIARY: g~rtfl~l'J '~ y~(-~Ut¢ L.
lIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORA'I-ION,
PARTNERSHIP
OR
TRUST:
II. SPECZFZC LOBBY ISSUE:
Issue to be'lobbied (Describe in detail):
C4'1¥ AGENC~ES/ZNDIV~DUALS TO BE LOBBTED:
A) Full Name of Individual/TiUe B) Relationship
f
FLATRATE OR OTHER):
2)
Pursuant to Ordinance No. 2003-3393 Amendincl Miami Beach City Code Chant~,r 2, Article VII, Division 5
Thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohib!t~t
CamDaian Contributions By Lobbyists On Procurement Issues":
Are you Iobbvinq on a Dresent or pendinq bid for qooa~ ~nuiDment or ser~ce_~, or on a present
or Dendinq award for qoods, equiDment or service? ~ No
Pursuant to Ordinance No. 2003-3395 Amendinq Hiami Beach City Code Chapter 2, Article VII Division ~
thereof Entitled "Campaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "ProhibitPd
CamDaian Contributions Bv Lobbyists On Real Estate Development Issues":
Are you Iobbvinq on a Dendinq aDplication for a Development Aareement with the City or
aDDliCa'CM~ for chanqe of zoninq map desiqnation or chanqe to the Citv's Future Land Use Map?
Yes Q~/
V. SIGNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR~ EACH LOBBYZST SHALL SUBMTr TO THE t~ ! '( CLERK A SZGNED
STATEMENT UNDER OATH, I..ZSTI'NG LOBBYZNG EXPENDTrURES ]'N THE cTrY OF MI'At4T BEACH FOR
THE PRECEDTNG CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true and correct and that ! 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 Lobbyi :s~
Signature of Principal/Client:
VZ. LOBBYZST t'DENTZFZCATZON:
- ~.~
[] Produced ID
Form of Identification
VIZ, SIGNATURE AND ~I'Af4P OF NOTARY OR DEPLrI'Y CLERK:
State of Florida, County of MiamFDade
Sworn to.._an):l subscribed before me ~L .
day of 2OO: T I
~ ~ . ~,~~r{ ~bl,c No~ ~te of Florida
~ OF~ FEB. 11.~O~ ~ .... (~ ~, x~ ~ I~ ~
Pnnt, ~mp or ~ name of No~ Public
FOR CLERK'S USE ONLY
Registration: [~ACCEPTED r ] RE]E~,II:O DATE:
If rejected, state mason:
Registration fee paid: ~;~Yes r ] No
2nd Revision 3/18/03
ENTERED BY~
F: \CL-ER\HATL\Lobbyists\registrationa 03.doc