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2016/2017 Clerk to the Board,Minutes &Records Dept. Expires " gi -�- 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Keith L. Bell Date 09/20/16 Business Address Clark Partington - Attorneys at Law 106 E. College Ave., Suite 600 Tallahassee, FL 32301-7721 E-Mail kbell@clarkpartington.com Business Telephone 850-597-7483 NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). San Felasco Nurseries, Inc. 7315 NW 126th St. Gainesville, FL 32653 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) ‹ ��� Lobbyist Signature State of Florida County of Cleliier LC t,(\ The foregoing registration was sworn to and subscribed before me on this 21 day of ,�+ n,Ck"3� 1felic ,by Ke t tot L•?-c-il) t. , who is personally known to me or has produced as identification and who did take an oath. •10k Y,' N i.= MY COMMISSION�R�210871 ��' fi �•y��;e= EXPIRES:October 25,2016 BY: `-/'� pF ;:• Bonded Thru NotaryPublic Underwriters Deprty 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. Receipt# 007719635 10/6/2016 11:09:00 AM Dwight E. Brock j Clerk of the Circuit Court Customer Deputy Clerk Clerk Office Location REMINGTON, BELL, KIRK, BMR CASHIER Collier County Govt. Center RAMBA MinutesandRecords@CollierClerk.co Building F, 4th Floor CLARK PARTINGTON m 3299 Tamiami Trail East, Suite 125 W ROMANA ST STE 800 239-252-2646 401 PENSACOLA, FL 32502-5856 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 4 BMR Lobbyist Registration $25.00 $100.00 TOTAL AMOUNT DUE $100.00 Check# 154843 ($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. ©o00n®tea® goy Page 1 of 1