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McCormick, TJ Date RECEIVED City Clerks Office CITY OF PARKLAND 6600 UNIVERSITY DRIVE APR 14 2016 PARKLAND, FL 33067 Ti111t7_ (954) 753-5040 FAX (954) 341-5161 By: LOBBYIST REGISTRATION STATEMENT Lobbyist Information Lobbyist Name M ��,f �,%,�1�1.L Q/yt� rine go,-,O) (Please print) Last % First Middle Lobbyist Address (Residence) q.3,,;r 1j,41 30# .5f #4Uet4�,,afl. ty State (Company/Firm) Ch�Cl�h cam' �cG Zi C g fe dT Business Name Business Address Pa (30k- City:�ro��c7 ; State: FL Zip Code �!3e,9 7Telephone y ,S CSFax Nature of Lobbyist Business, Occupation or Profession: O u4c h � Name of Principalm(frel�Inldl Last First Middle Business Name (,yCt�{r I 6",Mi,f,, Business Address PQ Bea- 970K,,� 1z 330V City State Zip Code Subje t matterr�that Lobby'st se]p/ s/}j/o influence (Ordinance/Resolution etc. describe in detail) Please state the extent of any business association by the lobbyist with any current elected or appointed official or employee of the City of Parkland. For the purposes of this article, the term"direct business association" shall mean any mutual endeavor undertaken for profit or compensation. Note: Appropriate authorization from the group, association, or organization that the lobbyist is representing must be attached. (Applicable minutes,motion, or other documentation of action) Page I 1 I understand that I am required to file, on an annual basis, a registration statement for each employer on whose behalf he or she lobbies before the city commission,board or city employee or official and to notify the City of any changes to the information contained herein. Further,I understand that each person who withdraws as a lobbyist for a particular person shall file a notice of withdrawal as a lobbyist with the city clerk. Annual Registration Fee of$150.00 to be included CERTIFICATION I do solemnly swear or affirm that all the foregoing facts are true and correct and that I have read the City of Parkland Code, Chapter 2.5 or Ordinance No. 2011-02, and that I am aware of the requirements for periodic filing and submission of other statements Signature STATE OF FLORIDA COUNTY /OFB�OWARD jI On this 11'1 day of r r ' 016 before me, the undersigned Notary Public of the State of Florida,personally appeared ; -m ( whose name(s)is/are subscribed and acknowledged that he/she executed it. Notary Public Notary Seal: Personally known to me WERLWEROACK roducedIdentification s WAq Pvbft-fto of FWWA ConajWw N FF 450641 MF Comm.Ex"don 14,2020 Page 12