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Biden, Frank Date ` ,�'(i CITY OF PARKLAND 6600 UNIVERSITY DRIVE PARKLAND, FL 33067 (954) 753-5040 FAX (954) 341-5161 LOBBYIST REGISTRATION STATEMENT Lobbyist Information Lobbyist Name /9/ /V (Please print) Last First ` Middle / Lobbyist Address (Residence) �-�� foci/j� /, 71 S 3!. Z City 9tate Zip Code Business Name(Company/Finn) f/O/(/ r ess 4 J/� f�BusnAsAdd 6 City: UW 3U3 �• 0 State: Zi Code 3 3� Telephones ax Nature of Lobbyist Business,Occupation or Profession: ��//'f/G %UIV Name of Principal La Fir t Middle Business Name ` A-1 'S/�'i/C /(�A ) Business Address City State $Code Subject matter that Lobbyist eeks tofluence(Ord',jj�LL /Res/olut' n etc. describe in d_eta'1) /yJ*ac J NI'U✓Gf s f�l� �C jU 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 endeavorlerta�cuundy 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 r Signature STATE OF FLORIDA COUNTY OF BROWARD On thisday C�z �,20%,before me,the undersigned Notary Public of the State of Florida,personally appeared whose name(s)is/are subscribed and acknowledged that he/she executed it. PublIV Notary Seal: L'�ersonally known to me Produced Identification JeWer Jdwom NOTARY PUBLIC STATE OF FLORIDA Cann*FF240504 Expires 7/17/2019 l f Page 12