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2013/2014 Collier County Clerk of Courts Expires 2©� 3299 Tamiami Trail E. (Clerk' tree only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name _ J 4 Date ZS 2 q 2 d 3 Business Name C o L+L f Ld LA r-! Y V Cl T ►r' L, G g / 7 \f f s r Business Address 3 *3 e d..)c C I 11- City P /` State , z— Zip Code 3 / 1 �- Business Telephone Contact Person Lobbyist E-mail 1 m l G-A/1 f ` C G f Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County Ordinance No.2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock,Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name / ,4/11 ea_sa " ame Address 0 F a-" L L ,v2 Address Co /- City Zip Code City Zip Code 3. Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier o b ist Signature I CL") �his registration was sworn(or affirmed)and subscribed before me this 20 day of v , 20 td by Personally Known BY: Mr' Allak Produced ID Deputy Clerk/Not. Public Type of ID Produced y•'.r,�'•., •.! :.:08/2011 Receipt# 007372704 8/29/2013 3:53:08 PM ;;.. Dwight E. Brock Clerk of the Circuit Court (TC )Off' a D joA7 j '•4 Customer Deputy Clerk Clerk Office Location JAMES G. FLAGLER BMR CASHIER Collier County Govt. Center COLLIER COUNTY VOTER MinutesandRecords @CollierClerk.co Building F, 4th Floor LOBBYIST m 3299 Tamiami Trail East, Suite 3403 BOCA CIEGA DR 239-252-2646 401 NAPLES, FL 34112-6809 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Cash Tendered ($25.00) BALANCE DUE $0.00 Note: Disclaimer:All transactions are subject to review/verification.The Clerk reserves the right to correct for clerical errors and to assess or refund charges as needed. CA IM®T©lkgeZogalgu Page 1 of 1 lire Collier County Clerk of Courts Effective Date 3299 Tamiami Trail E. (Cle 's office only) Suite 401,Bldg.F,46 Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST WITHDRAWAL FORM, Name I Date e'r ! — 2 '/3 Business Name Co LL/G,. _a q/7 ITE47 TC-' .7v7lJc5 Business Address —3 , or 3 6 O C i -- C/ ,,9- p Ems/17,E._ City ,4 6',75 State 1"—" Zip Code 39— 6a z— L-1 /S' Business Telephone Contact Person Lobbyist E-mail t ()[a e Q {Y) 1 , I, J l /1� l�L Q L F✓/z-- ,having registered in Collier County,on as a lobbyist,hereby submit a request for withdrawal. I understand that pursuant to Section 112.3148, of Florida Statutes,that my name shall continue to appear on the list of lobbyists until the expiration of the time period set forth in said statute. My last activity as a lobbyist was on 4-4 G- Z, , 20 t State of Florida County of Collier Lo u i yi igna re 1 This registration was sworn(or affirmed)and subscribed before me this day of, 4", , 20\-3,by vi Personally Known BY: ® P t Produced ID • • Depu ler°k/Not,' P blic / Type of ID Produced - , Re --. 00; 011