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2012/2013
Clerk to the Board, Minutes&Records Dept. Expires I 20 13 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Bradley Cornell Date 10/29/12 Business Address 1020 8th Avenue, South, Suite 2 Naples, FL 34102 Business Telephone 239-643-7822 E-Mail bcornell @collieraudubon.org NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Collier County Audubon Society 1020 8th Avenue, South, Suite 2 Naples, FL 34102 2) Audubon Florida 444 Brickell Avenue, Suite 850 Miami, FL 33131 (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) AP- Lobbyist Si ul to • State of Florida N County of Collier The fores,_oing registration was sworn to and s bscribed before me on this r't/P`>'l1 day of 2b(2-, by ` \� h\e�1 , who is personally known to me or has produced fL. A as id4 f*cail*arld. who did take an oath. 1:&" BY ' • .� Deputy Clerklotafy Public c.' - -i' The annual registration fee is $25.00 per Lobbyist,according to Collar t,ei ni j Ordinance No.2003-53,as amended by Ordinance 2004-05 and Ordinance'2007-24. Please make payment and mail to: Collier County Clerk of Courts or Dwight E.Brock,Clerk of Courts(at the address listed at the top of the form). Receipt# 007289632 10/30/2012 4:48:07 PM � Dwight E. Brock Clerk of the Circuit Court .., r (� )Off CMC'7.—1 `mss' _ < Customer Deputy Clerk Clerk Office Location BRADLEY CORNELL BMR CASHIER Collier County Govt. Center COLLIER COUNTY AUDUBON MinutesandRecords @CollierClerk.co Building F, 4th Floor SOCIETY m 3299 Tamiami Trail East, Suite 1020 8TH AVE S STE 2 239-252-2646 401 NAPLES, FL 34102-6959 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#2496 ($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. ©ODDhGglig 'lh❑gOG�IuI Page 1 of 1