Annual Lobbyist Registration Form t\A ! At\A B RECEIVED
City of Miami Beach NOV 09 2023
1700 Convention Center Drive
Miami Beach. Florida 33139 CITY OF MIAMI BEACH
www.miamibeachfl.gov OFFICE OF HE CITY CLERK
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: or 'f� ✓n-C-n_
Business Name: AR.--C.e ` ' l t1C„' /4 i
Address: 7.c:3C-) S c)wl` 14 ct C, �;#p /D CO/4-1/ + �l�l r� l .3(/Office Telephone Number: (��L (��
Cellular Telephone Number: br C.)
Email Address: / 6 Al, 6..(#0 1-; ( c 14,7
If more than one lobbyis'1, please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
l� l For City Clerk's Office Use Only
MCR #: /3-25 L( 7
Amount paid: � • Date paid: / 9
Processed by: 2 M Date:
F'\CLER\$ALL'aFORMSLLOBBYIST FORMS'ANNUAL LO88YfST REGISTRATION FORM reg.aocx
?3