Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvc1erklOlci. m iam i-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
COMMmEE; OR ANY ACTION,PEQSION 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 FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A OTY 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 ACTIVITIES
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 'CERTIFlCATE OF WITHDRAWAL.'
1) Lobbyist Name: ~~,.., ~ E
Last Name First Name \ Middle Initial
Business Phone ~ S-;).7().'io~ Message Phone L) ~
Business Address: "? t) ~ l'le?C)
A-- Nt~ ckrdAl.e..-
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State
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Zip Code
City
Email Address:
2)
Principal Retained by:
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VIA \-- <; ~ v ~\ tM eo d 'c-t.- \
'-\/0 \ IJ .I<<~ .l.\~ ~Je
tAl Street
VV\\h.t"\ ~
State
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)
If different from above
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Suite
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Zip Code
City
(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):
r--."A-.-_ ..e~",.l<:,
4. Identify each individual (Commissione~, Bo
to ~)pbbied: . VIA .
J>~J...t Ge- (
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
I
on 1 (~ t .2001
on E 2001
on . D 2001
on 2001
on . 2001
on . 2001
o The City Commission
o City Commission Subcommittee
o City Staff
o City Board or Committee
o Personnel
o Identify Others
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above: ~
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OA H, USTING LOBBYING EXPENDITURES IN
THE CITY OF MIAMI BEACH FOR THE CEDING CALENDAR YEAR.
I do solemnly swea~ that all of th re
am familiar with the provisions contain
amended, and all reporting requireme
Signature of L'Obbyist:
o ~nally knOW!l""\
~;~d~ced ID .~
~ take an oath, or
o Did not take an oath
cts are true and correct and that I have read or
ction 2-482 of ~he Miami Beach City Code as
.../
~o~-o br:'.S:2:-~f.:l--":O
, Identify ,," .
I.'.
,
"
State of florida, County of Miami-Dade
swor3land sUbscri~
This ~ 1- day 0'1' 001.
.It":
~1JA;-
or Deputy Clerk
1'"'.
If Notary, print, stamp or type as commissioned
Registration:
~D
FOR CLERK'S USE ONLY
[ ] REJECTED DATE: \~3 I ~ 0 J
,. \,.
If rejected, state reason: ~
Registrati,'on fee paid: ['t'fes [ ] No [,] Not-for-P~rgaqjz~tionJ '.
. C;c... - []Ca$h ~ ] Check MCR # ~ In !Q
DATA ENTRY DATE: .' '.", iOOlENTERED BY:'
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