Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive'
Miami Beach, FL 33139
citvclerk((j)ci. miami-beach. fl. us
AFFIOAVIT
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, RESOLlJTION, ACTION OR
DEOSION OF ANY COMMISSIONER; ANY ACTION, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMffiEE; OR ANY ACTION, DEOSION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKING PROCESS ON SUCH ACTION,
DEOSION OR RECOMMENDATION THAT FORESEEABLY WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMffiEE. THE TERM SPEOFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAL, 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 'CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: 6/E'Sel b.=ot<6~ JV' '
~st Name First Name Middle Initial
Business Phone ~ ?3B - 01 :35 Message Phone (_)
Business Address: /'5"0 r ~O~NS 4ve:-
/JI/ bn I /cfe:~~S~ .
Ow S~re
Email Address:.6e:7J1Z.ar:6~ChJ\Js./11Mlf)h./S. .
301
3 31 ~i~
Zip Code~
ea f'Y7
2) Principal Retained by:
~e- "ij-J ~c.Jlk:.
Street
Suite
If different /Tom above
r-
Ow
S~te
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): ~ r ~
- /VO/lp!- -Rd ~t11 !,?1".a+
P/Wn7&-w#Dc
4. Identify each individual (Commissioners, Boar ,Committee, Authority member or Oty staff)
to be lobbied: w -t ' i . .
"--
5. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
a The City Commission 1'6 4c M~OrJ~ on . 2001
a City Commission Subcommittee u,l)K,f)OI,).o on .2001
a City Staff ~ j)t>r.6E LiJ64>/Q v.obet. "~ Dr ~I'~k ~A!.A/"'M>&c:2001
a City Board or Committee c) A>1{vb4UJ on .2001
a personnelc.t.QllDr~~.e.A'.9) eJ.t>Aet. "~lJF 41t.&2XJ1ff ~..6"J~OG . 2001
a Identify Others J /}- 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: .
AYb J)E
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN
THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the for going facts are true and correct and that I have read or
am familiar with the provisions co Ined in Se on 2-482 of the Miami Beach City Code as
amended, and all reporting r . ements.
.,
Identify
Sig,,"ure of Lobbyist:
~ Personally known
a Produced 10
t..>V" Did take an oath, or
a Did not take an oath
State of Florida, County of Miami-Dade
Sworn ~ SUbscri~ before me
This day of I}-I}.A.f- , 2001.
N
MA.~IA T l.cm;;z
NOrARY PUilUG "TATE Of I'lORIOA
COMh1S:otON NO. crJ31a13
MYm,N::<Ar,;N EXP. AI'll.lO.2llOl
M~V~.C'.' .
~~QrD ~
J?14i2.ilt / 1-0 IE 2::
If Notary, print, stamp or type as commissioned
. fOR CUiRK'S USE ONLY .,
Registration: ~D [1 REJECTED DATE: ~?) i) I
If rejected, state reason: ~
Registration fee paid: M Yes [ 1 No [1 Not-tor-Profit Organization
CC-- [1 Cash [ 1 Check MeR # .
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.
"oj.
DATA ENTRY DATE:
. 2001
ENTERED BY: