Loading...
Siebert, Steven s O City Clerk's Office CITY OF PARKLAND 6600 UNIVERSITY DRIVE APR 14 2016 PARKLAND, FL 33067 Time: (954) 753-5040 FAX (954) 341-5161 BY: LOBBYIST REGISTRATION STATEMENT Lobbyist Information Lobbyist Name Siebert Steven W. (Please print) Last First Middle Lobbyist Address (Residence) 16978 Sierra Palms Dr, neiray Rr_h FI 334R4 City State Zip Code Business Name(Company/Firm) Stene Siebert /architecture Business Address 11 Q SF 4th AveSTF 1Q6, PtraV Rrh, F1 *T1483 (,�R)RR0 7 City: State: Zip Code Telephone Fax Nature of Lobbyist Business,Occupation or Profession: architect Name of Principal McCormick Timothy J. (TJ) Last First Middle Business Name _Costal Community Church Business Address 4789 RnweriinP Rd, Deerfield Beach,_El 33373 City state Zip Code Subject matter that Lobbyist seeks to influence(Ordinance/Resolution etc. describe in detail) seek (maxim,-ml dtawaloompnt of property on UPivarsity (for a GhwrGh) ��e� 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. none 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 d � 4 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 Signa e STATE OF FLORIDA COUNTY OF BROWARD On this day of n I 2016,before me,the undersigned Notary Public of the State of Florida,personally appeared �eo 11L ..Sic 6 er± whose name(s)is/are subscribed and acknowledged that he/she executed it. 1�7 =JAMIETM No blic Notary � NOM of FWM ona ly known to me ts Produced IdentificationMyc Page 12