HomeMy WebLinkAboutCody Thamann - KC Property Holdings Land Trust (Sanjay Jhaveri)MIAMI BEACH Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
305.673.7411
lobbyists@miamibeachfl.gov
LOBBYIST REGISTRATION FORM
RECt: l'VED
scr 21 •~<=>~-s-
c1TY O~ :.',!1'"'1 , 8EACH
Office -1E -r' CLERK
This form is required under Chapter 2, Article VII, Division 3 of the City Code for individuals who engage in lobbying activities
before the City of Miami Beach.
Pursuant to City Code Section 2-481, a "lobbyist" means any person employed, retained, or designated, whether paid or
not, by a principal who seeks to encourage the passage, defeat, or modification of any ordinance, resolution, action, or
decision of any Commissioner; any action, decision, or recommendation of the City Manager or any City board or committee;
or any action, decision, or recommendation of any City personnel1 during the time period of the entire decision-making
process on such action, decision, or recommendation that foreseeably will be heard or reviewed by the City Commission,
or a City board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term "lobbyist" specifically excludes the following persons: expert witnesses who provide only scientific,
technical, or other specialized information or testimony in public meetings; any person who only appears as a representative
of a neighborhood or homeowner association without compensation or reimbursement for the appearance, whether direct,
indirect, or contingent, solely to express support of or opposition to any item; and any person who only appears as a
representative of a not-for-profit community-based organization for the purpose of requesting a grant, without special
compensation or reimbursement for the appearance. Any person excluded from the definition of lobbyist under Section 2-
481 is not required to register as a lobbyist but must complete and submit a written disclosure form for each issue on which
they appear, identifying their name, address, and the principal on whose behalf they are communicating, as required by
Section 2-483{b) of the City Code.
Note: A separate form titled "Neighborhood/Homeowner Association Representative Registration Form" is available from
the Office of the City Clerk for representatives of neighborhood or homeowner associations. Other individuals excluded from
the definition of lobbyist under Section 2-481 may utilize this form and complete the relevant sections.
Instructions: Please complete all sections of this form and submit the completed form, with the applicable fee, to the Office
of the City Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to
report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or
any additional City Commissioner or personnel who are also sought to be lobbied, shall require that the lobbyist file an
amendment to the registration form. The lobbyist has a continuing duty to provide information and amend the forms filed
throughout the period during which lobbying occurs. A separate registration form must be submitted for each principal
represented and for each specific issue on which the lobbyist is engaged.
Lobbyist Registration Fees: Pursuant to Section 2-482 of the City Code, a registration fee of $350.00 per issue is required
at the time of filing this form. In addition, an annual registration fee of $500.00 is required for each 12-month period
commencing October 1 of each year. These fees must be submitted to the Office of the City Clerk along with the completed
registration form. However, a principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf
of that entity, without special compensation or reimbursement for the appearance, is not required to pay registration fees.
No fee is required for filing a notice of withdrawal. The City Commission may, in its discretion, waive the registration fee
upon a finding of financial hardship.
Public Records Notice and Address Disclosure: Forms filed with the Office of the City Clerk are public records under
Florida law. If your home address is exempt from disclosure or if you prefer it not be made public, you may provide an office
or alternate mailing address instead. Florida Statutes Section 119.071 (4)(d) provides public records exemptions for certain
individuals and their families. If you believe you qualify, please consult the statute or contact the Office of the City Clerk for
guidance.
1 City personnel include advisory personnel, autonomous personnel, departmental personnel, and quasi-judicial personnel.
Departmental personnel means the city manager, all assistant city managers, all department heads, all assistant and deputy
department heads, employees of the police department with the rank of captain, major or chief, building and zoning
inspectors, the city attorney, chief deputy city attorney and all assistant city attorneys; however, all departmental personnel
when acting in connection with administrative hearings, and any employee of a city department or division with the authority
to participate in procurement matters, when the communication involves such procurement, shall not be included for
purposes of this division.
Page 1 of 7
I. LOBBYIST INFORMATION:
Thamann
NAME OF LOBBYIST (Last)
Thamann Architecture + Design
LOBBYIST BUSINESS NAME AND ADDRESS
(786) 584 -7857
LOBBYIST BUSINESS TELEPHONE NUMBER
11. PRINCIPAL INFORMATION:
Jhaveri
NAME OF PRINCIPAL (Last)
KC Property Holdings Land Trust
PRINCIPAL BUSINESS NAME AND ADDRESS
(310) 739-2368
PRINCIPAL BUSINESS TELEPHONE NUMBER
Cody
(First)
1853 SW 24 Terrace
(Number and Street}
Miami
(City)
(Middle Name)
Florida
(State)
33145
(Zip Code)
cody@taplusd.com
CELLULAR TELEPHONE NUMBER
Sanjay
(Middle Name) (First)
7901 Hispanola Avenue Miami Beach Florida
(Number and Street) (City) (Stale)
EMAIL ADDRESS
33141
(Zip Code)
sanjay.jhaveri@gmail.com
CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to City Code Section 2-482(h)(1 )(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on
behalf of that entity, without special compensation or reimbursement for the appearance, whether direct, indirect, or contingent, to
express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay
any registration fees.
If the principal is a Corporation, Partnership, or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
•
•
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY (if none, write N/A): Sanjay Jhaveri, Manager/TruStee
NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST (if none, write N/A): _S_e_e_a_t_ta_c_h_e_d_. _________ _
Ill. ISSUE TO BE LOBBIED:
Describe the specific matter you are lobbying on. Include as much detail as possible, such as the title
or subject of the item, relevant ordinance or resolution numbers, RFP or 1TB numbers, or the date and
topic of any public hearing, if applicable.
Development Approvals & Planning Issues, including but not limited to the Historic Preservation,
Board, Design Review Board, Planning Board, Board of AdJustmenl, Land Use Development, City
Commission, and any City Workshops or Committees, if necessary, relating to the property located
at 50 W Di Lido Drive, in Miami Beach, Florida.
Page2 of7
IV. DISCLOSURE OF CONSIDERATION PROVIDED BY LOBBYISTS TO NEIGHBORHOOD OR
HOMEOWNER ASSOCIATIONS:
Pursuant to City Code Section 2-482(k), any lobbyist who provides, directly or indirectly, consideration,
whether monetary or non-monetary, of $1.000 or more to a neighborhood or homeowner association or
its designee, for purposes of supporting or withholding its objectiofl concerning a matter before the City
Commission, or any City board, or committee must disclose such consideration.
OYesl;!No: Have you provided, directly or indirectly, any consideration, monetary or non-monetary, of
$1,000 or more to a neighborhood or homeowner association or its designee, in connection
with the matter for which you are lobbying?
If yes, please describe:
N/A
V. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Staff for the Planning & Building Department None □ @
Public Works & City Administration, PB, HPB, BOA None □ @
ORB, City Commission, and Mayor as necessary None □ @
□ @
□ @
□ @
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial, or professional relationship, or other relationship giving rise to an
appearance of impropriety, with any current City Commissioner or City personnel who is sought to be
lobbied, as identified on the lobbyist registration form filed.
List any business, financial, familial, or professional relationship,
annearance of imoronrie'" lif none, write N/Al:
or other relationship giving rise to an
None
Page 3 of 7
VI. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION -BE SPECIFIC.
Contingency fees are strictly prohibited under Section 2-485.3 of the City Code. This
prohibition applies to all lobbyists and to individuals excluded from the definition of
lobbyist under Section 2-481. If compensation is not monetary, describe the form of
consideration (e.g., services, goods, etc.).
$250 per hour
The following six (6) questions MUST be answered:
1) Pursuant to City Code Section 2-488, entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
□ Yes !!I No: Are you lobbying on a present or pending bid for goods. equipment. or services1 or on a present or
pending award for goods, equipment. or services?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
□ Yes l!!!!I No: Are you lobbying on a pending application for a Development Agreement with the City or an
application for a change of zoning map designation or a change to the City's Future Land Use Map?
3) Pursuant to City Code Section 2-482{h), any person {except those exempt from the definition of "lobbyist" as set forth in Section
2-481) who only appears as a representative of a not-for-profit corporation or entity without special compensation or
reimbursement for the appearance, whether direct or indirect, to express support of or opposition to any item, shall register with
the City Clerk as required by this section, but shall not be required to pay any registration lees.
□ Yes !!I No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
Note: If you are exempt from the definition of lobbyist under Section 2-481 and are required to submit a written
disclosure pursuant to Section 2-483(b), representatives of neighborhood or homeowner associations should
use the "Neighborhood/Homeowner Association Representative Registration Form." Other exempt individuals
may utilize this Lobbyist Registration Form to fulfill the disclosure requirement and should complete the
applicable sections.
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical, or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood or homeowner association without compensation or reimbursement for the appearance,
whether direct, indirect, or contingent, solely to express support of or opposition to any item; and any person who only appears
as a representative of a not-for-profit community-based organization for the purpose of requesting a grant, without special
compensation or reimbursement for the appearance. Individuals who qualify for these exclusions are still required to submit
a written disclosure form for each appearance, as required by Section 2-483(b) of the City Code.
□ Yes !!I No: Do you qualify for one of the exclusions listed above under Section 2-481?
If yes, please check the applicable category:
D Expert witness providing only scientific, technical, or other specialized information or testimony in a public
meeting.
D Representative of a not-for-profit community-based organization requesting a grant without compensation
or reimbursement.
D Representative of a neighborhood or homeowner association appearing without compensation or
reimbursement.
Note: Representatives of neighborhood or homeowner associations should use the
"Neighborhood/Homeowner Association Representative Registration Form." Other exempt individuals may
utilize this Lobbyist Registration Form to fulfill the disclosure requirement and should complete the applicable
sections.
Page4 of?
5)
6)
Pursuant to City Code Section 2-491(1), no campaign conaultant ahatt lobby the City Commlulon for a period of 12 months
folloWlng the awearing In of any elected offldel(a) for whom Iha campaign conalMant provided campaign consulting lefVlces
within the past eledlon cyde. See Section 2-401 for moro Information.
a YN ■ No: Hayt you prpyldfd CIIDRIIAD con■uWng 11rylcn to IQ locMrobto1 rotrobt[ of tbt City CommlHIRD
W!Sblo V,, ptll tlfCUOQ cyclf? II YII, Pllllf 11•1 V,, lncumbfnt rotrnbtd•> of Vlt City Commi,11OO;
a YN a No: If vn, blf It Imo ltH than 12 month• •lact th• •ftclfd omcf•H•> whom vou p,oyfdtd c,mpafao
COOIMWOA ltlYICfl W111worn IDZ
Plnuant to City Code Section 2-482(1)(4)1., a lobbyist who has within the past election cycle provided campaign consulling
seNioes to an Incumbent member of the City Commission (which lobbying adMty Is not othetw!se prohibited by Code aedlon
2-491) shall disdose such particular aelVk:e on his'1ler lobbylat registration form and shan o,artv CMciose such particula( se,m
before lobbyjng the City Commission at a pubfic meeting.
a Y• ■ No: Hau you provided campaign consutttna urxlcu to 10 focvrobtot rn,mbfr of 1bt City CommtulOQ
wtthln the past •!,stlon cvsl•7 If YU, PIHH n,t UJt Incumbent membfrt•> of the City Comrnlfflon;
a Yes ■ No: It xn, wer, you promlffd or did xov J!Ctlv• economic GRDlldfmttoo lo 115cbfnae for campaign
con1u1t1na urvtcuz It xu, p1eau dffedbt the natur, and amount of •ox economtc comldtra1lo0 r,ceJvtd or promlffd lo t!Gbf 09• for campaign con,ultlna urvicu,
A IMPORTANT -Annual Requirements for Registered Lobbyist,: As a registered lobbyist, I acknowledge and agree to
the following yearty obligations. An annual registration fee of $500.00 must be paid by October 1 of each fiscal year to
maintain my lobbyist status active. A new issue registration fee of $350.00 is due when submitting any new issue registration
and is a one-time fee per issue. Additionally, I am required to file an Expenditure and Compensation Form annually by
February 28, which must include a signed statement of all lobbying-related expenditures and compensation. Once lobbying
activities for a specific issue have ended, I need to submit a Notice of Withdrawal using the same Expenditure and
Compensation Form. All forms should be se either via email to Lobbyists@miamibeachfl.gov or mailed to the Office of
the City Clerk at 1700 Convention Center , Miami Beach, FL 33139.
Signature of Lobbyist Date._...._f..,0
1,-;!t:-..c.-J,/_-z-r _______ _
I do solemnly swear or affirm at all of the foregoing facts, statements, and disclosures In this form are true and
correct, and that I have read and am famlllar with the provision• contained In Chapter 2, Article VII, Division 3,
entitled •Lobbyists," of the Miami Beach City Code, Including all applicable registration and 1'9porting
requirements.
I understand that violations of the City's lobbying ordinance are subject to enforcement by the Mlaml-Dade County
Comminlon on Ethics and Public Trust and may result In admonition, fines, public reprimands, prohibitions from
,-glstering u a lobbyist or engaging In lobbying activities by the City, debarment, or the voiding of contracts.
I further affinn that I am not receiving any compensation or reimbursement In violation of the City Code, and that I
am not engaged In any prohlb ad contingen fH amngemenL
Signature of Lobbyist Date,~/0.._P_l/.,_p....;5;....__ ____ _
Printed Name of Lobbyist ____________ _
Signature of Principal: Date, _____________ _
Printed Named Principal:._s_a_nJ_ay_J_h_av_e_rl _______ _
Pao• 6of7
Scanned with !
. i} CamScann~~:J
Scanned with
~ CamScanner·
5) Pursuant to Clly Code SecUon 2-491(1), no campaign consullanl shall lobby the Clly Commission for a period of 12 months
following the swearing In of any elected officlal(s) for whom the campaign consullanl provided campaign consulling services
within the past election cycle. See SecUon 2-491 for more lnformallon,
D Yes ■ No: Haye yoy provided campaign consulting sorvfcos to an Incumbent member of the City Commission
wfthfn tho past e)ectlon cycle? If yes, please Jlst tho fncumbent momber(s) of tho City Commission:
□Yes D No: If yes, has It been less than 12 months alnco tho ofectod offlclal(s) whom you provJded campaign
consulting services was sworn In?
6) Pursuant to Cily Code Section 2-482(a)(4)a., a lobbyist who has within the past elecllon cycle provided campaign consulting
services to an .incumbent member of the Clly Commission (which lobbying activity Is not otherwise prohibited by Code section
2-491) shall disclose such particular servlca on his/her lobbyist reglstraUon form and shall orally disclose such particular service
before lobbying the City Commission et a public meeting.
□ Yes ■ No: Have you provided campaign consulting services to an Incumbent member of the City Commission
within the past electjon cycle? If vas, please lf•t tho Incumbent memberfs} of the City Commlssfon:
□Yes ■ No: If yes, were you promised or did you receive economic consideration In exchange for campaign
consulting services? If yes, please describe the nature and amount of any economic consideration
received or pr9ml5gd In exchange for camoalan consultlna services,
•
A IMPORTANT -Annual Requirements for Registered Lobbyists: As a registered lobbyist, I acknowledge and agree to
the following yearly obligations. An annual registration fee of $500.00 must be paid by October 1 of each fiscal year to
maintain my lobbyist status active. A new Issue registration fee of $350.00 is due when submitting any new issue registration
and is a one-time fee per issue. Additionally, I am required to file an Expenditure and Compensation Form annually by
February 28, which must include a signed statement of all lobbying-related expenditures and compensation. Once lobbying
activities for a specific issue have ended, I need to submit a Notice of Withdrawal using the same Expenditure and
Compensation Form. All forms should be sent either via email to Lobbylsts@mlamlbeachfl.gov or mailed to the Office of
the City Clerk at 1700 Convention Center Drive, Miami Beach, FL 33139.
Signature of Lobbyist: Date _______________ _
I do solemnly swear or afflnn that all of the foregoing facts, statements, and disclosures In this fonn are true and
correct, and that I have read and am famllfar with the provisions contained In Chapter 2, Article VII, Division 3,
entitled "Lobbyists," of the Miami Beach City Code, Including all applicable registration and reporting
requirements.
I understand that violations of the City's lobbying ordinance are subject to enforcement by the Miami-Dade County
Commission on Ethics and Public Trust and may result in admonition, fines, public reprimands, prohibitions from
registering as a lobbyist or engaging In lobbying activities by the City, debannent, or tt:,e voiding of contracts.
I further afflnn that I am not receiving any compensation or reimbursement In violation of the City Code, and that I
am not engaged In any prohibited contingency fee arrangement.
Signature of Lobbyist: Date _______________ _
Printed Name of Lobbyist: _c_o_d_y_T_h_a_m_a_n_n ________ _
Signature of Principal:
Printed Name of Principal:._S_a_n_ja_y_J_h_a_v_e_ri ________ _
Date._/_,.P /l_/.....,1,_/2_z_gz.~> ____ _
I I
Page 5 of 7
VIII. NOTARY SIGNATURE AND SEAL:
LOBBYIST:
State of Florida ----------
County of: Miami-Dade
Sworn to (or affirmed) and subscribed before me.
by means or l!!!I physical presence
or D online notarization.
this 16 day of October , 20~5
Cody Thamann
NAME OF LOBBYIST
_x_Personally Know
Signature of Notary Public
Yeidy Montesino Perez
Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL)
YE\0'1' t,\QNTE.S\NO PEREZ
commission# HH 596999
Expires Janual'f 24, 2029
PRINCIPAL:
State of Florida ------------
County of: Miami-Dade
Sworn to (or affirmed) and subscribed before me,
by means of ~ physical presence
or D online notarization,
this 17 1 or. October
Sanjay Jhaveri
NAME OF PRINCIPAL
Produced ID _________ _
FORM OF IDENTIFICATI N
_x_Personally Known
Signature of Notary Public
Yeidy Montesino Perez
Name or Notary, Typed, Printed or Stamped
(NOTARY SEAL)
0,_.r-:.~ua<0 YEIOY MONTESINO PEREZ "'W Commission# HH 5116999
;~; Expires Januart 24, 2029
'"'f·of f\.0~
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ( ] Yes [ ] No Amount Paid$ _____ MCR # _________ Date Paid _____ _
Lobbyist Registration Form received and verified by: _______________ _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form REG KM RB OM NK REVISED OCTOBER 1 2025.docx
Revised: October 1, 2025
Page 6 of 7
MIAMI BEAC H
City ot M.loml l each, I /00 C.:onvonllOO C.:enlor Onvo, Miami Beach. Florido 33139. www.miomiboochfl.gov
Office of the City Clerk
Rafael E. Granado. City Clerk
Tel: 305.673.7411
CitvC!erk~miamjbeochfl gov
NAME OF LOBBYIST: Cody Thamann ---------------------
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d}, the City Clerk shall notify any lobbyist (or principal)
who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement}. In addition to any other penalties that may be imposed as provided in Section
2-485.1, a fine of $50.00 a day shall be assessed for Statements filed after the due date.
The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust
of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after
notification.
Any lobbyist who fails to file the required Statement by April 30th of each year shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on that
issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year. and the fee for such annual registration shall be
$5 O purs nt to Section 2-482 of the Miami Beach City Code.
Date
F"ICl..fR\SAll.loFORMS\l.088YIST FORM$1U)lll)ylll Rog,llrlllOn Fann REO KM RO OM NK REVISED OCT06ER 1 202~ <100<
Page 7 of 7
Scanned with
i} CamScanner
Exhibit B
Disclosure of interest for •Kc Property Holdincs LLC"
Sanjay Jhaveri, Manager
n1 Brickell Avenue, Suite 500
Miami, FL 33131
100%
DISCLOSURE OF INTEREST
TRUSTEE
Page 7 ofB
If the property that is the subject of the application is awned or leased by a trust, list any and all trustees and benefidaries of
the trust, and the percentage of interest held by each. If the aWners consist al one or more carporaiians, parfnersliips, trusts,
partnerships or other corporate entittes, the applicant shall further disclose the identity of the indJvidual(s) (natural persons)
havlng the ultlmate ownership interest in the entity. .
KC Property Holdings Land Trust
TRUST NAME
NAME AND ADDRESS
KC Property Holdings LLC, Trustee ,
Please see Exhibit B "Disclosure.of Interest" 'v'. , . t
Sanjay Jhaveri, Beneficiary
777 Brickell Avenue, Suite 500
Miami, FL 33131
%INTEREST
100%
We ore committed to providing excellent public service and safef'( to all who five, work, and play in our vibrant, tropical, historic communily.
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH ... ,..... 1
□ Cash □ Credit Card □Check ff ___ 1 __
435937 NO.-_::...~...;::_: __
) $-------,
-~------20----
Received of _____________ ,_, _____________ _
~
Address-,------------------------------
City of Mianu Beach
Miscellaneous -MCR -2026
008386-0043 Ebani Th ... 11/04/2025 05: 0lPM
MCR OPEN (MCR)
Payment Amount: $850.00
(THIS INFORMATION MUST BE COMPLETED)
Office of Finance Director
EXT:_'--_
City of Miami Beach
Customer -Service Center
1755 Merdian Ave Suite 100
Miami Beach, FL 33139
305-673-7420
j/e lcome
11/04/2025 05:0lPM Ebani T.
008386-0043
MISCELLANEOUS
MGR OPEN (MCRJ
Reference 1: MCR_435937
2026 MGR
1 ® $850,00 $850,00
$850.00
Subtotal $850.00
Total $850.00
CHECK $350. 00
Check N11mbe r-002219
CHECK $500 . 00
Cheers Number002246
Change due $0.00
Paid by: BERCON RADELL FERNANDEZ LARKIN
llllll!llllllllll!llllllllllllllllllllllllllllllillillilllllllllllll
iHBP i PPI\P
Mfl-4F @ 75? HP MA
Thank you for your payment
CUSTOMER COPY