2014/2015 Clerk to the Board, Minutes & Records Dept. Expires ( -I/201 S
3299 Tamiami Trail East, Suite #401 (Staff use onl )
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Clifford I. Hertz Date 5/7/15
Business Address 1 N. Clematis St., Suite 500
West Palm Beach, FL 33401
Business Telephone 561 .832.3300 E-Mail chertz @broadandcassel.com
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). MARUTI TRANSIT GROUP LLC
8550 Touchton #1626 Jacksonville, FL 32216
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY)
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this 7 -
day of 181G, ` , X 015 , by C.I,ffocd —k kZ , w . is personally knowi o
me or has ps duced as lien ' ca ion and
who did take an oath.
, tr. y CHRISTINA L SHORE
:+; • .. MY COMMISSION It FF 122632 '
EXPIRES:May 13,2018
b,,
Th Notary Pudic Uncle rite
Deputy C1.4 otary Public
The annual registration fee is $25.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24
and Ordinance 2013-39.
Please make payment to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts and mail to the address listed at the top of the form.
lAc .wiptrr VVI JJI IJJ
5/11/2015 3:53:08 PM
Dwight E. Brock
Clerk of the Circuit Court
Customer Deputy Clerk Clerk Office Location
CLIFFORD I. HERTZ BMR CASHIER Collier County Govt. Center
BROAD AND CASSEL MinutesandRecords @CollierClerk.co Building F, 4th Floor
1 N CLEMATIS ST STE 500 m 3299 Tamiami Trail East, Suite
WEST PALM BEACH, FL 239-252-2646 401
33401-5552 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
Check# 39967 ($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.
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