Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerktlllci. m iam i-beach. fl. us
AFFIDAVIT
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTION OR
DEOSION OF ANY COMMISSIONER; ANY ACTION, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMmEE; OR ANY ACTION, DEOSION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKlNG PROCESS ON SUCH ACTION,
DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMmEE. THE TERM SPEOFICALL Y INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTI"mES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH
PERSON WHO WITHDRAW A LOBBYIST IS REQUIR~LE A 'CERTIFICATE OF WITHDRAWAL..
1) Lobbyist Name: Jll/I o-J 2>fad ~
Last Name First Name Middle Initial
Business Phone .M) ;1 d..-/ 7~6 ) Message Phone (3'~ ~ 7'3 e::csY.?
Business Address: /// E .21.6~ .h .
/lJ/-'/n / N~"", Stree~L .:3SJ!;-
Oty . ,;State / Zip Code
Email Address: :::6rhw pJa.;.) 2> d ~ ~~ ~I '7ta-1-
2) Principal Retained by: 'Ill; r G' & 6v'
e2666 /1/-05v?7or)
If different from above Street
~/h'7?1 fe.#-C~
City
c/
~
State
Suite
.3 5/~ :7
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): ~S?""" Y ~/,..-.Y g~~5~~ /"
4. Identify each indiy.idual (Commi . ers, Board,
to be lobbied: L.dn.h4. t
r Oty staff)
erA--
,.;..
"1"",
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
The City Commission on I '/0 .200 ;-
I
0 City Commission Subcommittee on .200
0 City Staff on .200
0 City Board or Committee on .200
0 Personnel on .200
0 Identify Others on .20
6. State the extent of any business, financial, familial, professionaLqr other relationship which
exists with any individual identified in number (4) above: .,.;vC).1/JE..
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OATH, LIS1lNG 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 reqUire~ ~
Signature of Lobbyist: 4- ~ /
o Personally known
o Produced ID
P /3::2-()(.:,(-Ji:-~/fo-O
Identify
o Did take an oath, or
o Did not take an oath
State of Florida, County of Miami-Dade
Sworn t9"and sUbscri~d before me
This '1!:b dayof ~. 2001.
rtiFL
~~
Notary or De rk
If Notary, print, stamp or type as commissioned
FOR CLERK'S USE ONLY
Registration: 94 ACCEPTED [] REJECTED
If rejected, state reason:
Registration fee paid: ~ Yes [ ] No [] Not-far-Profit Rr9!l~ti~
YJ Cash [ ] Check MCR # =' '3;:5 '-(-
DATA ENTRY DATE: 1/11] /0 f . 2001 ENTERED BY: ~
DATE:
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