HomeMy Public PortalAboutVan Smith, Jean - Registration - Florida HospitalCity of Orlando
Lobbyist Registration From
(One Client Per Registration Form)
1. Lobbyist Information:
Name: °JPail V r Sn
Z5 2c _)“ x Avenue, S.t,t-€ 200
Mailing Address:
city O1an dr) State: FL Zip 3MC5-I
Email y),1,/cInSrni}%)p hone: (2-0..303-2852) Fax:
11. Client/I'rincipallnforntation
Name:
Florida Ncxp A
Business: e..&41 Care
Business Address: .2 520 .gorl-hC �e kenie , �.�lJi+e. PD
City: Or\nit() J State: VI Zip: 32 SC)11
Is your client:
Corporation /
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).
ture
earn V2iv1 Srr h
Print Naive
lIt/ / 1-6
Date