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2013/2014 Collier County Clerk of Courts ExpirLOq/ C) 15 3299 Tamiami Trail E. (Clerk's office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name }--R-N t–n.L � \\ ` � Date a. 3 Business Name a fit- ■) M..-S Business Address (p City Tt, C State L.-C Zip Code 3 3--3 0 Business Telephone x t jcl-o. )100 Contact Person '- Lobbyist E-mail "'" M.���. 1� S �- Co 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 b. S 2. Name Address Address City ci3 1..O(? 1sfC-- 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 L bbyist Signature This registration_ as swo r affi ed)and subscribed before me this L� .day+of *r(-- g ) , 2014 , by _ Personally Known BY: CLUA444 •44, Produced Produced ID /� Depu e ary Publi c Type of ID Produced �Q • Revised:08/2611 Receipt# 007487773 9/23/2014 8:45:20 AM ;;,,� 1 Dwight E. Brock ' Clerk of the Circuit Court r V :y` I L _.h, �! I 1 LT-'._ , 1 I 1i - ( III Customer Deputy Clerk Clerk Office Location FRANK MATTHEWS BMR CASHIER Collier County Govt. Center HOPPING GREEN & SAMS MinutesandRecords @CollierClerk.co Building F, 4th Floor PO BOX 6566 m 3299 Tamiami Trail East, Suite TALLAHASSEE, FL 32314- 239-252-2646 401 6566 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. /©001hDv©U ogg[01] Page 1 of 1