HomeMy Public PortalAboutFitzgerald, Miranda - Registration - Coalition For The Homeless of Central FloridaCity iz
Lobbyist Registration Fortin
(One Client Per Registration Form)
Part I — Lobbyist Information
Lobbyist Name: / it-ai eazip/
Mailing Address: of 5 At, Lc I p._
StateF — Zip: c
Business Phone: l{O%gi{3yr6to Ext.31-1CS Fax:4D1 $Lt'�j li4 14
Email:r r (,\ 1 .t�r h era,' ciartd rs-' kw.) ,COP
Date: f' —1 l�
Part II — Principal/Entity (Provide information on the client, customer, or company you represent)
NameL.Dati ; 'fro() �`C�f t
' 01 e 1Tp» p re45 C..9'1 1 (br � l &
Business: /ieyy �,-,C I T
Business Address: e, '1 /t2 e-01) 1722-% c ivcf
City: Vr f r J State:lr_Zip: cS-00
Is your client:
Corporation [ ] Partnership [ ] Type:
Association [ ] Trust [ ] Name:
I understand that I may be required to file an expenditure report on February lst and August lst of
each calendar year and that to the best of my knowledge, the above information is correct.
Signature
Print Name