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2016/2017 Clerk to the Board, Minutes& Records Dept. Expires q lid/// 0 p / i7 3299 Tamiami Trail East, Suite#401 (Staff use only Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM (Bruce Barone, Jr, Carolyn Tieger) Tieger Barone 5/4/17 Name Date 678 5th Ave N, Naples, FL 34102 Business Address 239.777.1822 or 202.670 bruce@tiegerbarone.com Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: TBD 1). TBD 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) Lobbyist Signature State of Florida r \ fur_0,4„ County of Collier The foregoing registration was sworn to and subscribed before me on this day of ,by , who is personally known to me or has produced as identification and who did take an oath. BY: 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. Rea,iplit 007800544 611/2017 8:47:40 AM Dwight E. Brock Clerk of the Calait Cotnt ffo@ a e©eop * F customer Deputy Clerk clerk Office Location BRUCE M BARONE JR BMR CASHIER Cother CountyGovt. Center TIEGER BARONE ndR- •• ,. .co :. ,.., . F,4th Fk r 878 5TH AVE N 3299 Tamiami Trail Suite NAPLES,FL 34102-5502 239-252-2646 401 P.O. Box 413044 Naples, Florida 34101-3044 1 Product + ' UNIT COST AMOUNT, I! BMR Lobbyist - $25.00 $25.00 FEE°iv FEE HAW AMY TOTAL I tiiit Lobbyist telaseision Fee o0 TOTAL AMOUNT Checka 409 $25.0®. BALANCE .tt Oisdahosr: The .. correct for oksicai errors taxi So assess cr rt charges as needed. C& llierC err . €s Paw 1 of 1