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2014/2015
Collier County Clerk of Courts Expires 3299 Tamiami Trail E. (Clerk's o ice only) Suite 401,Bldg. F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name O - C�P��o Date ?-e_ /4f Business Name P(L(V"lE - ec AT" P O E / F t'('S / (-1 O. Business Address Lf 6C( �%2tI - S� S *4 C City 14O LA,yw w0 State Zip Code 3-O Z l Business Telephone 3 2 -8-188 Contact Person � i t� C-t'f'c-i?� p ��H) � Lobbyist E-mail '1C) ('�Z.�11�c't Rai PUS 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 l'.lNe t S AT PoZC R,C,tCName Address (657 4;14 , sr: 5o(r: 1/a-v Address City (.f.tewa O Zip Code 33M(( 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 Lobbyist Sig. a This egistration�`w{{as sworn(or of e• and subscribed before me this day, of, c-•201`t by �1 ► ;'. • Personally Known BY: Produced ID Deputy Clerk/Not. , Publ c Type of ID Produced L, _ ised:08/2011 Receipt# 007483794 9/8/2014 1:52:14 PM Dwight E. Brock Clerk of the Circuit Court Customer Deputy Clerk Clerk Office Location JORGE S. CEPERO BMR CASHIER Collier County Govt. Center PRINME HOMES AT MinutesandRecords @CollierClerk.co Building F, 4th Floor PROTOFINO m 3299 Tamiami Trail East, Suite 4651 SHERIDAN ST STE 480 239-252-2646 401 HOLLYWOOD, FL 33021-3430 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 ($40.00) Cash Returned $15.00 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. ©CDC bilgTg @[ ogOGuli Page 1 of 1