HomeMy WebLinkAboutMichael Milberg/Mark Siffin City of Miami Beach Office of the City Clerk
1700 Convenlion Center Drive, Miami Beach, FL 33139
Emaih dtyderk~::i.miami -beach.fl .us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
C] Check Box if an Amendment
NAME OF LOBBYIST: (Last) ' ( ' )
(M.I) DATE QUALIH~U AS LOBBYIST
I. LOBBYIST RETAINED BY:
NA~I-E OF P~NaPAUCl TENT: ! ' '
BUSINESS ADDRESS: (Number and Street) -- (City) (State) ~.~ ~ (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if prlndpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· N~M.E OF CHIEF OFFICER, P/~RTNER, OR BENEFICIARY:
. LIST ALL PER,cONS HOLDING, DIRECTLY OR INDIRECll.Y, A 5% OR MORE OWNERSHIP INTEREST IN 5UCI-I
CORPORA'HON, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
, _ r~ d._.._. ~,..,'~,,...
Is~tie to be lobbied (Describe in detail):
'rtl'. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
r ...,~_-_-. · ,-.. ~.,..- ..- ~ ~, kg.,...,., L,,t-. .
82/85/2884 13:56 3856848447 MAEFIELD DEVELOPMENT
~TR~ OR ~
Th~rcof EnfiSed '~. _nn ~na~e r~',~J" '"' .......
2)
· ~lwin~ ~ a oresen~ er ~--,.no bld for nn'~- "ou;oment Or- ' orona
Af~ you loll a _ , .....
Puq;Vant to Ordlnance. J~l~ 2DOq. La:_.,~: A~T~J~Inq.,vJ~arnl I~ach Clev r'n,~. (::~aoter 2~ A~cle ',~I ~;on 5
~;~' EnUtled "Caf, ba;~r, Fina0~e Re~iT#'. Via The Addition.Df C..0~8 SecUo~ 2-490 B,i~,ad 'Tru;-~b~
Cam n butlons bs4sts On Real E,~:'ate Dev~~
PAGE 81/01
p.~,4~2
~ mi · ent wl~ tile
· deM m'd~a M
5TA'I'EI~I~r UNDER OATH, "z~mzNb
THE p~1NG 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-q82 o~ the Miami BeaCh City Code as amended, and
reporting requirementSc~
Signature of Lobbyls~:
Signature of Prir~dpal/
v,.. I~F~.AT~ON-' ~- ,: pets°nal]y Known
State of Florida, County of Nlaml4)ade
Sworn to and subscribed before me (
· ............. SHANNON CHNV~giNN
1 .-"~:?'-. NotCU'¥ Public- State of F
¶%..~d,/ Commission # DD281754
/GBBYZb'T ZDEN'~F2CKI'~ON:
prOCIL~"~ ZD
For
~G-NATt,II~ AMD STAMP 01~ NOTARY OR DLRR'TTY C['~R~
~qa~,=u~ fee ~d: 1.~ :~ No
DATA ENTRY DATE:
2nd Reul~c]n 3/18103
nature of Public Notary
Print, stamp or ~ name of Notary Public
TOT~IL P. 02