Affidavit
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk(Cilci. miami-beach. fl. 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, ACTlON OR DEOSION OF ANY COMMISSIONER; ANY
ACTION, DECISION, RECOMMENDATION OF ANY CITY BOARD OR COMMmEE; OR ANY ACTlON, DEOSION OR RECOMMENDATION
OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTlON, DURING THE TIME PERIOD OF THE ENTIRE DEOSION-MAKlNG
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 SPEOFICALLY INCLUDES THE PRINOPAL AS WELL AS ANY AGENT,
ATrORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTIVTI1ES FALL WITHIN THE
NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATrORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A
LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL,"
1) Lobbyist Name: /J,q l Sf'~ lJc.frtGtJo
Last Name First Name
Business Phone (30)) '(1(1- 117 Z. Message Phone eOr)
3!~ 1lf-H-IIht/tt.4 C I,LC<-e-
Business Name and Address:
71/
Middle! Initial
772-SI89
No.
Street
4
Suite
Co""",,- G.4(lLt.~
City
Ii...-
State
3311'1
Zip Code
Email Address:
2)
Principal Retained by:
QUI I!..
if.lA..(
'iy....,
Street
h
State
j{"" 1 ~k- "..tA.
If different from above
/o..-r r 41'V1 f
City
Suite
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):
1'''1(/.." 1,16 (..0" o"C/<4-I/ONS
.
4. Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: C
/-1'1 Co""'/SSI""; T /fo""N,S1JW1?,O,.)
5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or
individual):
;D The Oty Commission (P/<P on .2001
D City Commission Subcommittee on .2001
D Oty Staff on .2001
D City Board or Committee on .2001
D Personnel on ,2001
D 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:
NONe
ON OCTOBER 1 Sf 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 foregoing facts are true and correct and that I have read or <lm familiar
with the provisions contained in Section 2-482 of the Miami Beach Oty Code as amended, and all reporting
requirements. /?l ~ J
Signature of lobbyist: \.. Y ~. c; .
D Personally known
Ji. Produced 10
J:'t.Ort dw f)n.;.....S
Identify
~, c..""-s <=-
~ +::ut> 01 0 1~ 4u (J
D Did take an oath, or
D Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 2001.
~dw J~,~
~ or Deputy Oerk
If Notary, print, stamp or type as commissioned
Registration: [(4. ACCEPTED [] REJECTED
If rejected, state reason: /'
Registration fee paid: [uxes [ ] No [] Not-for-Profit Organization
[ ] Cash [ ] Check
DATA ENTRY DATE: ~ o../0./"
FOR CLERK'S USE ONLY
DATE: ft./{g/Ol
MCR# -;:D
. 2001 ENTERED BY:r'S