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Affidavit . - , - ~ - CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 cityclerk@lci.miami-beach.f1.us AFFIDAVIT 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, RESOLUTION, ACTION OR DECISION OF ANY COMMISSIONER; ANY ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMITTEE; OR ANY ACTION, DEOSION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DE,ClSION-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 PRINOPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVmES 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: GLAAI .:z;,.."t" Last Name First Name .5 Middle Initial Business Phone ~f) I.JI(,~ S95'r Business Name and Address: CII",. IIJ,~ 3lQS' Q~..J. t-, ~ I SUrf. 200 No. Street Suite Message Phone k)&.f"t~$I4'c. ::rAN.. CMAL ~.'U' City nolllPlt State ;J"J'f Zip Code 2) Email Address:(ja-J.II/.._..~l....~...ltl.ClIlIuu-_.CDItfI . Principal Retained by: C/II;L WM~~ :r~_ .3"5'" ~~c. d. Lou"", '&vD. If different from above Street r,.,~ GoA-s f'uut.IM City State 5"l7e ~O Suite .3!>'3"f Zip Code (a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner, beneficiary or interests. L.WDA ~ Po Ii. 3lClS QNu 6. \.c.". -:It')..OO CDltAoI. G:a....~... ft... 50s I'!'f 3) Subject Matter (Describe in Detail): os 'I. Identify each individual (Commissioners, Board, Committee, Authority member or City staff) to be lobbied: . " PI' t)L.L C6".;';AI~-Maf1r.; c.rry MA-~"'.L I ~'1lA.TIO'" ~"'I"'''~.c ~ Ci-ry StAtt. 5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or individual): on {"I', on on 71lA on 7'61t on on -r8A .2001 .2001 .2001 .2001 .2001 .2001 K The City Commission o City Commission Subcommittee " City Staff _ City Board or Committee o Personnel " Identify Others 6. State the extent of any business, financial, familial, prof~ssional or other relationship which exists with any individual identified in number (4) above: _No 1.e&.,",IO"S'~I}) ON OCTOBER 1ST 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 Section 2-482 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: )f. Personally known o Produced ID fkr~U. ~ Identify ~ o Did take an oath, or 'JI. Did not take an oath State of Florida, County of Miami-Dade Sworn to and subscribed b\lfore me This 14 day of 1J!J!t'l . 2001. V~"!='k Fa VAllCHNSOAIlIiS NOlARY PIlBLlCsrATIlOF I'LOllIDA COMMISSION NO. C1:J'15aJ11 MY COMMISSION EXP. SEPI' 14 If Notary, print, stamp or type as commissioned FOR CLERK'S USE ONLY Registration: r;Q ACCEPTED [l REJECTED DATE: H UJ l~;> ;;2..01> I If rejected, state reason: Registration fee paid: [\A'Yes [ 1 No [l Not-for-Profit9rganization [ lCash t(<lCheck MCR# ~5 qB 0 DATA ENTRY DATE: . 2001 ENTERED BY: