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Affidavit (04/18/2001) '" m CITY OF MIAMI BEACH OFFICE OFTHE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 citvcierk(QJci .mi2mi-beacn.fi .us AFFIDAVIT LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHElHE;>, PAID OR NOT, BY A PP1NCP,'.L WHO SEEKS TO ENCOURAGE THE PASSAGE, DEf'EAT OR MODIFICft,TiON OF ANY ORDINANCE, RESOLUTiON, ACTION OR DEOSION OF ANY COMMISSIONER; ANY ACTiON DEOS;ON RECOMMENDATION OF ANY CITY eo~RC Oi! COr-1MITTE=; OR ANY ACTION, DECISION OR RECO(.U.1ENOAnON OF ANY PERSONNP.. DEFlNED IN ANY t-1ANNER It-l THIS SECTiON, DURING THE TII'-1E PERlOO OF THE E!'4TIRE DECIS10N-Mt>.i<lNG PROCeSS e.N Sl.JCH ACTION, DEGS10N OR RECOMr-1ENDA110N THAT FORESE~.8LY WI~L BE HEt1,RD OR RevIEWED BY THE cin' COMMISSION, OR p. CITY BOARD OR COM~1ITTE=, THE TERM SPECIFlC~LL Y INCLUDES THE PRlNGPAL AS WELL AS ANY ,~GE'n, ATTORN,,', OFi'ICER OR E,'1PLOYEE OF A PRJNOPP.,L, REGARDLESS OF WHETHER SUCH LOBBYING ACTWTTiES F,.lLL WITHIN THE NORMft,L SCOPE OF EI'.,PLOYMENT OF SUCH AGENT, ATTORNEY, OFP1CcR OR EHPLOYE::: E.~C-! PERSON WHO WITHORA.WS AS A LOBBYIST IS REQUIRED 70 F1lE A "CERTIFICATE OF WrTHDPAWA.L." 1) Lobbyist Name: PI ~ W Name J-1 Me- First Name Middle Initial Business Phone~ .5 $g - DJ 3.5 Of; L U U..r M 5tr~H Stace Message Phone C. _j_ _ 6/~ --.63" ; ~19.~ -~ -~-~._-_._-. Zip Code Business Address: (0' OJ Ioe1J-e!iI2 ' /YIt ,{J-,>lI City Emaii Address: &>m~(!J;-i).. _r/-f I- ~~~ 2) Principal Retained by: , If different from above S~"';:::lc:>r Suite City State Zip Code (a) If a corporation, partnership, or trust, identify and provide the address for the c~ief officer, partner, beneficiary or interests. 3) Subject Matter (Describe in Detail): _ 9-~}, ~h~ 4. Identify each individual (Commissioners, Board, Committee, Authority member or Oty staff) to be lobbied: -/!r1-A.. ._ ,,__, _ .. ..... . ~, The subject matter in number three (3) above is to be considered at the me::::ting or (Identify each entity or individual): )(J The City C8mmission Xl City Commission Subcommittee XI City Staff ro City Board or Committee Q Personnel Q Identify Others on on on on 2001 ______~________, 2 GC 1 20l)] ___._______.12.001 on __._~_. _ ..___J 2001 ..__' 2001 on 6. State the Extent of any business, financial, familial; professional or other re\ationS~lip which E~;(ist.s 'J'Jith any individual identified in number (4) above: ----.N_an.e...-.,____._____,.__.._~._. ON OCTOBER 1ST OF EACH YEA~ EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LIJ.:r:IN6-+0BBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CAlE~IDAR YE,AR. I do solemnly swear that all of the fOI "'YUICltj 'dL1'S are t:-ue 2rYJ correct and that I have read or am familiar with the provisions cOl')tained in Section 7-482 of the Miami Beach City Code as amended, and all reporting requirements. MAluA T tDPEZ NOfAIIYPUBLK ':l'I ATJ:OF FLORIDA COMMISSIOi' ,~o ')0010418 MY COMMISSION EXP. APIt 10 Signature of Lobbyist. XIX Personally known ::J Produced lD MX Did take an oath, Or :J Did not take an o2th StaLe of Fionda, County of Miami.Dade Sworn to and subscribed before me ThIS /. 1- O?" ^oF 1/-'1 ~I L _ 2001 -----."-----.----., , P,egl5traricn: [~PTED FOR CLERK'S USE ONLY <i) f/~ ( ( 1 REJECTED D,"'TE: I I L., If rejected, S"'"L2te reason: Registration fee paid: r es [ J No [] Not-for~Profit OrganizatlQn [ ] Cash [ ] Cneck MeR # DATA ENTRY DATE; f /1 f /0 f ,2001 ENTERED ~_~ ~,____,__