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2016/2017 Clerk to the Board, Minutes & Records Dept. Expires 01 /2017 3299 Tamiami Trail East, Suite #401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name J. Wayne Everett Date 06.08.17 Business Address 10541 Ben C Pratt 6 Mile Cypress Pkwy. Fort Myers, FL 33966 239-225-2600 jweverett@drhorton.com Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1) DR Horton, Inc. 10541 Ben C Pratt 6 Mile Cypress Pkwy. Fort Myers, FL 33966 2). (PLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY) I Lobby Signature State of Florida County of Collier The foregoing registration was sworri to and subscribed before me on this 13 day of J „e_ , by J. Qh� E✓e✓e , who is personally known to_ rr or has produced y/ as identification and who did take an oa. MEAGAN KRAFJACK a .; MY COMMISSION N FF 212945 EXPIRES:March 23,2019 ,Or ' RF Off, Bonded Thru Notary Public Underwriters • • �_ i i D-puty C - 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# 007806488 6/19/2017 2:53:13 PM Dwight E. Brock Clerk of the Circuit Court gif EDER Customer Deputy Clerk Clerk Office Location J. WAYNE EVERETT BMR CASHIER Collier County Govt. Center D.R. HORTON MinutesandRecords@CollierClerk.co Building F, 4th Floor 10541 BEN C. PRATT/6 MILE m 3299 Tamiami Trail East, Suite CYPRESS PKWY. 239-252-2646 401 FORT MYERS, FL 33966 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# 601473 ($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. ©0000®[r@h ❑gg ] Page 1 of 1