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Lobbyist Registration From
(One Client Per Registration Form)
I. Lobbyist Information:
Name: jpWiid�S hr'D eki b lei141,61r qe g
Mailing Address:
City ealerd0 State: pr, Zip .1;15.(,•5'.
4) Lea" Amid ei) keihile,544404feeil
Email: Phone: 4o'/ ' 1/We Fax:1141.a 1/44 d
IL Client/Principal Information
Name: 6 (4rry 1466 (t`CG3
Business: Cr1iiida 41/6a11e W1.1/4E1 h01 eObte;" c 4bla /J�`b i t aialcie)
Business Address: 492,11 lea J4 ash err &(N, 5lu t ie 4'11)
City: 14wielo State: PL Zip: 3Z frZ1
Is your client:
Corporation P(
Association [
Partnership [ ] Type:
Trust [ ] Name:
To the best of my knowledge, the above information is correct. I understand that pursuant to
City Code sec. 2.191(4), I am required to file an expenditure report on February 1st and August
1st of each calendar year of any lobbying expenditures involving the City during the preceding
six month period (January -June, July -December).
Signaturep
Print Name "9
Date