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2012/2013 Collier County Clerk of Courts Expires 20/3 3299 Tamiami Trail E. (Cler Cl/2_0 s office only) Suite 401, Bldg. F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Kris W. Thoemke, Ph.D., C.E.P. Date October 1, 2012 Business Name_Coastal Engineering Consultants, Inc. Business Address 3106 South Horseshoe Drive City Naples State FL Zip Code 34104 Business Telephone 239-643-2324 Contact Person Sarah Bunn Lobbyist E-mail kthoemke(&cecifl.com Notice for Lobbyists: The annual registration fee is 525.00 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: *(VARIOUS CLIENTS—AS CONSULTANTS MEET AND DISCUSS VARIOUS ISSUES WITH COUNTY STAFF AND BCC MEMBERS) 1. Name 2. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier obbyist Signature This registration was sworn(or affirmed) and subscribed before me this 5 W-1 day of, ( *6x r , 20 E � , by `ivPC. (, ,?, 77 1C(P • Personally Known BY: �,4 Produced ID eputy otary P lic Type of ID Produced roe"w:•P`,'e% KAREN J.TAY * ,`!Y MY COMMISSION f EE LOR 214682 * un EXPIRES:October 1,2016 d1440F FvoPOe Bonded Thru Budget Noisy Services Revised:08/2011 Receipt# 007285194 10/12/2012 10:26:37 AM 0.'s>,��_"'� ;T Dwight E. Brock `,J Clerk of the Circuit Court 4 a 0 pa( ° ETE3(C17 °-- 11,Dc__ , , c:, Customer Deputy Clerk Clerk Office Location ROBERT A. ANDREA, BMR CASHIER Collier County Govt. Center MICHAEL T. POFF, MICHAEL MinutesandRecords @CollierClerk.co Building F, 4th Floor F. STEPHEN & KRIS W. m 3299 Tamiami Trail East, Suite THOEMKE 239-252-2646 401 COASTAL ENGINEERING P.O. Box 413044 CONSULTANTS, INC. Naples, Florida 34101-3044 3106 HORSESHOE DR S NAPLES, FL 34104-6137 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 4 BMR Lobbyist Registration $25.00 $100.00 TOTAL AMOUNT DUE $100.00 Check# 064038 ($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. ©OaOGG©DgG'OCK❑@CM Page 1 of 1