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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
citvclerk@ci,miami-beach.fI.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 DEOSION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY 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 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 COMMmEE, THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINOPAl, REGARDLESS OF WHETHER SUCH LOBBYING ACTlVmES 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 WITH~WAL."
1) Lobbyist Name: ~~v-l..e<; ~~ I -
Last Name First Name Middle Initial
Business Phone ~S) 3'1'71-"3 S:4 Message Phone (_)
Business Name and Address: _~ ~ 2.. ~~ , f, <A-_
. ,
{DO S ~ :l..t,J Sf-. ~~ '31LD , ~'l R- "3~("'3/
No. Street ( Suite City' r State
Email Address: (,V' ~ e a...,.( bYv'o
2) Principal Retained by: D:""" p~~ ~~ {L+.J "
/ t, L. l( tJ 'E ( g +t... a......-
If different from above Street
N.~' ~L h--
City Sta'te
Zip Code
Suite
33(~2...
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner,
beneficiary or interes~:ol-F ~Lr
,
3)
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
tObelobbied~ of ~~~~ c~'",-<r~
nrh ~_~ ~,' c\h ~ -t ~~
] I ~
S. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual): dv ~ k~",,-,,-,.~
Q The City Commission on .2001
Q City Commission Subcommittee on ,2001
Q City Staff on ,2001
Q City Board or Committee on ,2001
Q Personnel on .2001
Q 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: 11 ~
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ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 ction 2-482 of the Miami Beach City Code as amended, and all reporting
requirements.
Sign~re of Lobbyist:
'l::J"Personally known
Q Produced ID
~ake an oath, or
Q Did not take an oath
Identify
State of Florida, County of Miami-Dade
sw~nd sUbscri~e m,e
Thi day of 2001.
f:Q..6~~
If Notary, print, stamp or type as commissioned
Registration:
~ED
[ ]
FOR CLERK'S USE ONLY ~
REJECTED DATE: 6/ l+-(
If rejected, state reason: _
Registration fee paid: ~ [ ] No [] Not-for-Profit Organization
[ ] Cash [ Check~MCR #
DATA ENTRY DATE:
2001
ENTERED BY'