Les Beilinson/Altos del MarCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emaih cityderk@cLmiami-beach.fl.us
LOBBYZST REGZSTRATZON FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
NAME OF LOBBYIST:
'TqD NW
BUSINESS ADDRESS:
Check Box if an Amendment
(Last)
(Number and Street)
TELEPHONE NUMBER:
(First) (M.[)
(City)
FAX NUMBER:
(State) (Zip Code)
EMAIL:
I. -- LOBBYIST RETAINED BY:
klAME OF PRINCIPAL/CLIENT:
BUSINESS ADDRESS: (Number and Street)
TELEPHONE NUMBER:
(City) (State)
(Zip Code)
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] · NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARy: ,~~'~1~
LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECIFZC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CITY AGENCZES/INDZVZDUALS TO BE LOBBZED:.
A) Full Name of Zndividual/Title
ZV. Dt'SCLOSURE OF TERMS AND AMOUNTS OF LOBBY!ST COMPENSATZON (DISCLOSE WHETHER lfOURL Y~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
1)
Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chapter 2, Article WI, Division 5
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Procurement Issues":
2)
· Are lVOu !obbvinq on a Dresent or Dendinq bid for qOOds, eauiDrnent or services, or on a D~esent
or Dendina award for qoods, eauiDment or service? 0 Yes ~] Nn
Pursuant to Ordinance No. 2003~3395.Amendina Miami Beach Citv'Code ChaDter 2, Article VH Division 5
thereof Entitled "Campaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
CamDaion Contributi0n~ By Lobbyists On Real Estate Develooment Issues":
Are you Iobbvina on a Dendinq application for a Development Aareement with the City pr
cation for chanqe of zoninq mad desiqnation or chanqe to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER Is'r OF EACH YEAR, EACH LOBBYZST SHALL SUBHTr TO THE CZTY CLERK A SXGNED
STATEMENT UNDER OATH, I.zs'r!NG LOBBYING EXPENDZTURES I~N THE CTTY OF MZAM! BEACH FOR
THE PRECEDZNG 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. ..~....~,.~/~.
S~gnature of Lobbyist: ~ ~ ~
Signature of Principal/Client: _ ~ -~ ,
VZ. LOBBYIST XDENTZFZCATZON: ' ~ '*
o Produced ID _/?~"~-~:~>- ~;~,~//.d~/~,~-~--~ Personally Known
Form of Identification
VZX. SXGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This /~'~ day of ~z-~C~./~-~_ , 2004.
Signature of Public Nota~ - State of Flodda
Print, stamp or type name of Notary Public
Registration: [ (~ACCEPTED
FOR CLERK'S USE ONLY ,
c] DA :
Registration fee paid: [ ~ [ ] No , [ ] Cash [ ] Check MCR Cf
DATA ENTRY DATE: (.,~/ /'7.~10Y .LNg)3 ENTERED BY:
I
2nd Revision 3/18/03
F:\CLER\$ALL\EL/ZABb-r\Lobbylist\registrationa04,doc