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Milholland, Jack Lobbyist # M - 41060 I M Collier Joint Ventures Lobbyist Name: Jack Milholland E-mail: jmilholland@atcoinc.com Date Received Details 4(24 6 G Kl.A,v C.06104,t- - 9109 Saved as: (Q drive)Lobbyist Data Sheet rn "ap . /10 ,�,�E CiRCG� County of Collier *4`31 .41//� �, CLERK OF THE CIRCUIT COURT 446 0 W te"Mr. }_ zr .r �G COLLIER COUNTY COURTHOUSE ��E1\ 3301 TAMIAMI TRAIL EAST P.O. BOX 413044 NAPLES, FLORIDA 34101-3044 cDUhn"� Dwight E. Brock ORIGINAL Clerk OFFICIAL RECEIPT -''4 nA7n, '71c When Validated --- - - BY: ANN J DEPUTY CLERK RECEIPT: 5645054 DESCRIPTION AMOUNT NAME : JACK MILHOLLAND LOBBYIST 25 . 00 PAYOR: JACK MILHOLLAND REFNC: APJ DEPT: BOARD MINUTES AND RECORDS TOTAL DUE : 25 . 00 Page 01 of 01 Board Minutes & Records Expires: 2009 April 2 3301-Tamiami Trail East Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name: Jack Milholland, Jr. VP/General Manager Date: 2009 April 2 Business Address: Merit Petroleum Company P. 0. Box 816 LaBelle, Florida 33975 Business Telephone: +1 (863) 675-2301 Email: jmilholland @atcoinc.com NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1. Merit Petroleum, Inc. P. 0. Box 816 LaBelle, Florida 33975 PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY st14/ 1 obbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this day of ntiarch, 001 , by .3a0.,k u , m lhv(Jcivd�Jr , who is personally known to me as identification and who did take an oath. ,,.. JOO4A. , • Nom PubMc.SIN•d RAN anNonE> OD MPN, 'Si'Q1 BY: ;s// 1 •- � Cpk Cpn�ai••bn f b67J4 • • 4-1/ Wad TIwouellelomi NolryAssn. • puty Clerk/Notary Public The annual registration fee is $25.00 per Lobbyist, according to Collier county Ordinance No. 2003-53,as amended by Ordinance 2004-05 and Ordinance 2007-24. Please make payment and mail to:Collier County Clerk of Courts or Dwight E. Brock, clerk of Courts (at the address listed at the top of the form).