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2013/2014 Collier County Clerk of Courts Expires q ic 97 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 k-/l4lt-GU Z)mod / �•, Date _d Z°P7- n' Business Name X061 J / SD�IA/ LL C Business Address 3e,5o /-1p/1Si'r It �At l/ - /74 City AkiPt State --"e__ Zip Code 3'0i Business Telephone Z39 20 6 040 Contact Person ,6y44/t-co f oQ,pc Lobbyist E-mail s/ Ap iQ J -- t9,12s otit 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: - .A 4 P 2 t1"iO4 1. Name / 7/7�'- 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) State of Florida County of Collier Lobby' t Signature This registration as swo or affirmed and subscribed before me this I day of, ) Y , 20t , by 1 Personally Known B • ,_ `"arL roduced ID 1 Deputy Clerk/Notary Public ype of ID Produced �� c\JQ-r L( ., Revised.08/2011 Hacienda Lakes of Naples, LLC 3921 Prospect Ave Naples, FL 34104 Star Development Co. 3232 W. Lake Mary Blvd. Lake Mary, FL 32746 Star Financial 3232 W. Lake Mary Blvd. Lake Mary, FL 32746 SFI Naples Reserve, LLC 3232 W. Lake Mary Blvd. Lake Mary FL 32746 Receipt# 007449374 5/15/2014 9:12:45 AM rK< \ Dwight E. Brock Clerk of the Circuit Court K,_ ED o a (S D)Viii C-- c- C7 C-e' '— Customer Deputy Clerk Clerk Office Location EMILIO J ROBAU BMR CASHIER Collier County Govt. Center ROBAU AND ASSOCIATES, MinutesandRecords @CollierClerk.co Building F, 4th Floor LLC m 3299 Tamiami Trail East, Suite 3050 HORSESHOE DR N 239-252-2646 401 NAPLES, FL 34104-7911 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. ©000rla0g ❑@0Ial Page 1 of 1