Affidavit (02/01/2001)
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerklOlci. miam 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, 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 OTY 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 Fllfj "CERTIFICATE OF WITHDRAWAL.'
1) Lobbyist Name5. -f;t~~~V' l.;-src::.A-lcl. i< '
Last Name First Name " Middle Initial
Business Phone (~b? ~ "I J 0 I Message Phone (_)
.
Business Address: III I t.<..i.c. C,.6./,.; ~.P 'I at!)
w,,,,,,,," .e~<::-~ Street?%'/. 3 3/ ~i~
City State Zip Code
EmailAddress: Gt=RA-lo/ j::: ~ SOIltf,/';'eo...c.J... .tA~, c.~
2) Principal Retained by: C t...~ k<- C!..rnu(.""",,'c..o.h~.s.
/68"/ 7r"F 8y-.
If different from above Street
N, ~.., rlr '14';I/4r.~ <. '7-/
Ity ( State
Suite
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Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
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3) Subject MaEter (Describe in Detail): V~~ :l"rJla..lle...rs uJud-,
HdM.r'L",A Q l1Mod/e.rs. j3"".Q.dL i < "z"'c, - 1 lVlo..tf~"'.S/
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('"' .....& e. ~ e.<":....
4. Identify each individual (Commissione ,Board, Committee, Authority member or Oty staff)
to be lobbied: dI . C!...e::.
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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 .2001
0 City Commission Subcommittee on .2001
0 City Staff on ,2001
0 City Board or Committee on .2001
0 Personnel on .2001
0 Identify Others on ,2001
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above: ~
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ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL ~UBMIT TO THE CITY
CLERK A SIGNED STATEM.E~T UNDER OATH, USTINGlOBBYINGEXPENDITURES IN
THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing facts are true an/j 'correctand that I have read or
am familiar with the provisions con ined in Section 2-482 of the Mi ,BeClch City Code as
amended, and all reporting If. nts.. . ., ' ' ".
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Signature Qf LQblilyist:
~ Personally knOW, ~
r prod~ced ID. i '. ", "
o Did take an'dath; dr ..'
~ Did not take an oath
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:w~~",-J\~ " \-'{ (l)",,;:'o..\. " ..
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, Identify ,., , .
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State of Florida, County of Miami-Dade
Sworn to 'ana subscribed before me
This day of . 2001.
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Notary or Deputy Clerk
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If Notary; print, stamp or type as commissioned
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/ FOR CLERK'S USE ~L y,
Registration: tJ4.-ACCE~D'[] REJECTED DATE:
If rejected, state reason:
Registration fee paid: es [ ] No [] Not-far-Profit organjzati~J 1 rOf ::J.-
] QlSh )'[1 C~eck. flI~ #.: " rL._ ::J.... 'f2 I.
. 2001 : ENTERED BY: ..
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DATA ENTRY DATE:
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