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John Rapaport oCEIO Office City Clerk` O s f VA, Date ©16 CITY OF PARKLAND 1113W_ L1 . ;. 6600 UNIVERSITY DRIVE Br• PARKLAND, FL 33067 (954) 753-5040 FAX (954) 341-5161 LOBBYIST REGISTRATION STATEMENT Lobbyist Information Lobbyist Name (Please print) Last — First Middle Lobbyist Address(Residence) �f.�e °:1' a�"il ' C �'r-,(` "t (.:;1�:; ? , City State Zip Code Business Name(Company/Firm) Business Address :t�j.';;_:.>', Y; �;r't'''< �.�,'�''�di' City: State: y Z Zip Code :A i,!--i Telephone L���`J�r 7 4 Fax ?:`1, Nature of Lobbyist Business,Occupation or Profession: , 4 Name of Principal tjo, Last First Middle Business Name Business Address City State Zip Code Subject matter that Lobbyist seeks to influence(Ordinance/Resolution etc.describe in detail) lrit {e\cc,+ �`m. .�f.Z �:Y'.<,'e. '�; O,.l,f Please state the extent of any business association by the lobbyist with any current elected or appointed official or employee of the City of Parldand. 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 I CERTIFICATION I do solemnly swear or affirm that all the foregoing facts are true andcorrect and that I have read the City of Parkland Code,Chapter 2.5 or Ordinance No.2011-02, at I am aware of the re uimments for periodic filing and submission of other statements S' ature STATE OF FLORIDA COUNTY OF BROWARD On this day of >/V; before e,the undersigned Notary Public of the State of Florida,personally a peared whose name(s)is/are subscribed and acknowledged that he/she execute it. Notar ublic Notary Seal; JULIE ANNE peMORE Personally known to me NOTARY PUBUC-STAT@ OF FLORIDA COMMIsSION#FF134205 Produced Identification EXPIRES 8!18/2018 DONDEDTHRU1 NOTARY' i Page2 ism 24301 Walden Center Drive wc Bonita Springs, Florida 34134 239.498.8200 Your Best Address. wcicommunities.com April 21, 2016 Jennifer Johnson City of Parkland 6600 University Drive Parkland, FL 33067 Re: Lobbyist Registration Dear Ms. Johnson: Enclosed please find the Lobbyist Registration Statement and registration fee for Jon Rapaport. Thank you for your assistance. Should you have any questions, please call me at (239) 498- 8214. Sincerely, �� Mary Cook