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2015/2016 Clerk to the Board, Minutes&Records Dept. Expires0 4 �1� 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name J6b 112- --.5 1-4 Date 6 /D/47 Business Address 7-7Z4 Cate.. ►Z LOS C F+ Akyer3 3390 Business Telephone 239-Z71 ' -J 0/0 E-Mail `, ) t413. nc/i NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). "6©US 2). (4ce,roc. �e biro i r to m anc; Com hevto r-\oi . S-+e, IDI) Aa--1( r\46L , 3o1 (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 al s t• day of Jur' , by Teti Tr-C. h ,who is personally known to me or has produced as identification and who did take an oath. •:�""'r"�..,,._ DIANNAQUIW'fANiLIA ,n := MY COMMISSION t FF 051804 BY: iit_ L d_ L t nI .�-��:A; EXPIRES:September 5,2017 '1,801P Bonded Thru Notary Public Unerweru Deputy Clerk/Notary Public The annual registration fee is$25.00 per Lobbyist, accordin 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. A 1 VVVItJL1f VVI VVJ!VL 6/22/2016 11:24:49 AM Dwight E. Brock \\`, Clerk of the Circuit Court fit - 0 - 1Dch-\@em, E: 'DER 0 Customer Deputy Clerk Clerk Office Location A. FITZGERALD, B. BMR CASHIER Collier County Govt. Center GALLAND, T. HARDY, T. MinutesandRecords@CollierClerk.co Building F, 4th Floor TREESH m 3299 Tamiami Trail East, Suite COLEMAN, YOVANOVICH & 239-252-2646 401 KOESTER, P.A. P.O. Box 413044 4001 TAMIAMI TRL N STE 300 Naples, Florida 34101-3044 NAPLES, FL 34103-3591 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 4 BMR Lobbyist Registration $25.00 $100.00 TOTAL AMOUNT DUE $100.00 Check# 27724 ($100.00) 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. ©®DD11WOQgg[IM Page 1 of 1