Affidavit (01/05/2001)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerklOlci. m ia mi -beach. fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, 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, RECOMMENDATION OF ANY OTY BOARD OR
COMt1mEE; OR ANY ACTION, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DECISION-MAKING PROCESS ON SUCH ACTION,
DECISION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIvmES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL."
C0
1)
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First Name
Middle Initial
Lobbyist Name: /" Q I't{./0
Last Name
Business Phone (;31b) 3'71- (). 3(
Business Address:
/l/JI ~.1
, City
Email Address:
"<j(,,~,,,
Message Phone (_)
61,(CCA..V'" (71.{ / ,rI,
Street k
State
aw
No.
fff1)
.JJ/J6 Suite
Zip ode
2)
~, "etained by:
, ih~
If different from above
f-k GrM (L('
Street
Suite
City
State
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
3)
Subject Matter (Describe in Detail):
6(jJJ j 4JJvJVV'.I~ ,/)vWid,qj
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: ~(...{,+ A{;v1,,-. ~,
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
0 The City Commission on .2000
0 City Commission Subcommittee on ,2000
~ City Staff .-5d rY Aj on ,2000
City Board or Committee on <::5<:t1 S- .2000dCAJ!
0 Personnel on ,2000
0 Identify Others on .2000
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above: /i. dv'le
,
ON JULY 1 Sf OF EACH YEAR, EACH LOBBYST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USTING A 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. ~ A A I ./1
Signature of Lobbyist: ~ ~ ~
~rSOnallY known .
o Produced ID
.,p/'Did take an oath, or
o Did not take an oath
Identify
State of Florida, County of Miami-Dade
Swor.Qtq pnd subscr~ d before me
This ')~ day 0 2000.
~~
~ or Deputy Clerk
If Notary, print, stamp or type as commissioned
Registration: [] ACCEPTED
FOR CLERK'S USE ONLY
[ ] REJECTED DATE: I ~S - U \
If rejected, state reason: _____
Registration fee paid: ['"1Yes [ J No L-J Not-for-Profit Organization
[ ] Cash [LJ-Et1&k MCR #
DATA ENTRY DATE:
.2000
ENTERED BY: