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2014/2015 Clerk to the Board, Minutes& Records Dept. Expires ?)q 12/315 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM ee//c.e it!/1.2d.,7../i i % '.3.--..s..-/-745s—.7-s- .'1�c . Name .¢2''D .;�4, . Date i z 3 Business Address � � ),�4 . 2 ���f/ ice- '�/d`V Business Telephone v237,,X.3-- 2of7- E-Mail /.li9,PCd�t� / el,,D/X, NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). mare./US za% ...1>�-5- 7,,,''°e''f;,7 1 , 2). ,-7444.A..•.--e c., 5 i9›,7 a/ el wr,-to (PLEASE ATTACH ADDITIONAL SHEETS, IF NECES AR Lob'ist Sign. re State of Florida County of Collier The foregoing registration was sw2m to and subscribed before me on this O hrt ' /4 day of( e��� y C� _ , rn- , who is personally known to me or h produced t 6- "- },,, 11,..3/i'7 as identification and who did take an oath. JOSHUA S.ICENT .41i NOTARY f'�JBLIC �� STATE OF FLORIDA e s" -";'Comm#EE846883 BY: 41 Expires 10/28/2016 Deputy Clerk/Notary 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. I I.IpLm UV I Jr ULVV 7/6/2015 2:12:29 PM Dwight E. Brock Clerk of the Circuit Court o ©ff@I Customer Deputy Clerk Clerk Office Location MARCO A. ESPINAR BMR CASHIER Collier County Govt. Center COLLIER ENVIRONMENTAL MinutesandRecords @CollierClerk.co Building F, 4th Floor CONSULTANTS, INC. m 3299 Tamiami Trail East, Suite 3880 ESTEY AVE 239-252-2646 401 NAPLES, FL 34104-4457 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# 2534 ($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. ©000U0ggga Page 1 of 1