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Registered Office & Agent Form • • SPECIAL DISTRICT REPORTING Section 189.416, Florida Statutes, requires that each special district in the state designate a registered office and a registered agent and file this infonination with . the Department of Community Affairs and the local governing authority, Collier County Board of County Commissioners. Any changes in registered agent and registered office must be reported to the above named agencies. In the space below, please provide the correct name and address of your current registered agent: DISTRICT NAME.: North Naples Fire Control & Rescue District REGISTERED AGENT: Fire Chief :!f"i _.5 "atef-, REGISTERED OFFICE: 1885 Veterans Park Drive Naples FL 34109 • In addition, please provide the telephone number of your registered agent. PHONE NUMBER: (239) 597-3222 • Indicate your district's status (dependent or independent) by marking and X in the appropriate space. (See section 189.403, Florida Statutes, for definitions) • DEPENDENT INDEPENDENT X If the actual location of your special district office is different from that of your registered agent, provide the district's business address in the space below: • Please return this Colin, to the address below: Derek Johnssen, General Accounting Manager Clerk of the Circuit Court Finance Department Court Plaza III 2671 Airport Road South Naples, FL 34112 •