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2011/2012
Collier County Clerk of Courts Expires q/794791--- 3299 Tamiami Trail E. (Cler office only) Suite 401, Bldg. F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name GEORGE H HERMANSON Date /3/41// Business Name HOLE MONTES, INC. Business Address 950 ENCORE WAY City NAPLES State FL Zip Code 34110 Business Telephone 239-254-2000 Contact Person Lobbyist E-mail georgehermanson(a hmeng.com 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: (See Attached List) 1. Name 2.Name Address Address City Zip Code City Zip Code 3. Name 4. Name Address Address City Zip Code City `' Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) PIia°" State of Florida County of Collier Lobbyist Signature This registration was sworn(or affirmed) . d su•scribed before me this Oki^ day of, , 20 11 , by -�" �.-.... Personally Known ,,•,::;:e! ��N► Produced ID 1 _ Notary Public•sate r<�;� , Clerk/Notary ' b1 s My Com .Expire }Type of ID Produced 1 +� Commission r�� Bonded Through National Notary Ann. — —— — — — — • — Revised:08/2011 Receipt# 007195586 10/17/2011 3:16:03 PM <()zti Dwight E. Brock Clerk of the Circuit Court 7 0 D e p Customer Deputy Clerk Clerk Office Location GEORGE H. HERMANSON BMR CASHIER Collier County Govt. Center HOLE MONTES, INC. MinutesandRecords @CollierClerk.co Building F, 4th Floor 950 ENCORE WAY m 3299 Tamiami Trail East, Suite NAPLES, FL 34110-9176 239-252-2646 401 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#47189 ($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. ©®[1[IngTglgrilhoggCM Page 1 of 1