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Steven Marin/Fla Graffiti Cntrl "" t' ... I m -...,.. City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Email: cityderk@ci.miami-beach.f1.us LOBBYIST REGISTRATION FORM - (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) ~ Check Box if an Amendment /f\ ~ ~ I/"'-... NAME OF LOBBYIST: (Last) s~~/'- (First) (, (Number and 3o..s ? (I ~ '-I-_~~ TELEPHONE NUMBER: .30 < 97/37/ / FAX NUMBER: <Vf)(jjJ(YlcA.k I~' EMAIL: (!t5 II'- I. LOBBYIST RETAINED BY: ~dC*.- ~k.-2.~+r (R'(7~DI; I^~ --- NAME OF P N PAL/CUENT: 00 5 EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: ~.J /Y\.I ~.s=e/'y J:>&-s{d~ . UST ALL PERSoNs HOLDING, DIREffi Y OR INDIREd Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~'f'o<=...~ /Y\;~Q/Ar lool€) Od:)/"f<!:'~Ar( n. SPECFIC LOBBY ISSUE: . I ~k~// Issue to be 100 ied (Descri e in etail): cJt;/^-.fr(() I C) m. CITY AGENCIES/INDMDUALS TO BE LOBBIED: --I -< A) Full Name of Individual/Title B) Relationship ("") ,." :;:0 m () m < m o (- J.v. LI.I.~Kl:ur ICKPI:::'A.n1L1"...uunl::tur LUDDll:::>>1 \"U"'I'Crt::tA,lJ.un lUJ.::M..LU::tC WnClnCK nVUI<L.T, FLAr:V\l1:0R OTHER): I A) lOBBYIST DISCLOSURE: J S 00 ~ Mu" JL R (b fat't1e f' B) PRINOPAl'S DISCLOSURE (OF LOBBYIST COMPENSATION): 9XJ i~ 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division S Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Procurement Issues": Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eauiDment or services. or on a Dresent or DendinG award for GOods. eGUiDment or service? Yes No 2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division 5 . thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY LobbYists On Real Estate Deyelooment Issues": Are YOU lobbyinG on a DendinG aDDlication for a DeyeloDment AGreement with the City or aDDlication for chanGe of zoninG maD desiGnation or change to the City's Future Land Use MaD? Yes No 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: Form of lrentification VI. LOBBYIST IDENTIFICATION: IJ Produced ID VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: , ------ Sig ture of P ic Notary - ,State of Florida j;~~ -frtA----f-o Print, stamp or type name of Notary Public ./" FORCLERK'SUSEONLY I II Registration: ~CEPTED [ ] REJECTED DATE: f '2.- P ! () ~ I If rejected, state reason: l ~(t) . ~ Registration fee paid: [ ] Yes [ ] No [ ] Cash k M~_----, DATA ENTRY DATE: tf)?D .~ ENTERED BY~ 2nd Revision 3/18/03 F:\CLER\HATL\lobbyists\registrationa03.doc to - CITY OF MIAMI BEACH BIENNIAL LOBBYIST REGISTRATION DATE REGISTERED: , 2000 J7\ ~;',,- LAST NAME, .sle{)'e~ FIRST NAME, LOBBYIST NAME MIDDLE BUSINESS NAME fi/l~ t'/,,- a.p\._l, - C::;-e~ ,/~ I (IF DIFFERENT FROM ABOVE) BUSINESS PHONE t~ 7' "7. I ~ ~~ MAILING ADDRESS / ~3 D 9 ,c:::::c.....D J 9-4- c::..-"'" ,41/ . a N\.J 1=/ J ~A--~ 33 IS> 4 BUSINESS ADDRESS I DO SOLEMNLY SWEAR THAT ALL FACTS CONTAINED IN THIS BIENNIAL REGISTRATION REPORT ARE TRUE AND CORRECT, AND THAT I HAVE READ AND AM FAMIUAR WITH THE PROVISIONS OF MIAMI BEACH ORDINANCE 2000- 3243 (AMENDED 5/10/00), AND THE LOBBYIST REGISTRATION, REPORTING, AND WITHDRAWAL REQUIREMENTS CONTAINED THEREIN. l\Y Pit OFRCIALNOTARYSEAL o...t- <9<,~ IVETTE PINTO 1 c,: COMM1~ION NUMBER ... <( 00087452 71> ~ MY COMMISSION EXPIRES OF f\.O FEB. l' .2006 ....--srG~BYlsr STATE OF FLORIDA, COUNTY OF MIAMI-DADE SWORN TO ~SCRlBED BEFORE ~~~ . METHIS J AYOF-4fkJl ,200 ~~ -'_ N UTYCL t~ BIENNIAL REGISTRATION FEE $125.00 PAID $ I PAYABLE ON EACH EVEN-NUMBERED DATE YEARS CASH REC'D BY: 381 :l.:lO S,JI~J31:J HI: I I : II WV 0 2 Cid~ ~O ) DEPUTY CLERK: a3^13~3~ ......