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2009/2010 Board Minutes & Records 3301 Tamiami Trail East Building F, 4th Floor Naples, FL 34112 Expires: 9/ fJOj!) / BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name: Carol A. Licko Date: August 6, 2010 Business Address: Hogan Lovells US LLP 1111 Brickell Avenue. Suite 1900 Miami, Florida 33131 Business Telephone: +1 (305) 459-6612 Email: carol.licko@hoganlovells.com NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1. Jackson Laboratory 600 Main Street Bar Harbor, ME 04609 PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY ~a~~ Lobbyist Signature State of Florida County of r on r M.t'i::lO'v'_l-Ot'~-e... The foregoing registration was sworn to and subscribed before me on this 0 ~ day of P<v?JvS'tr ~b( 0 ' by Co..'(1') \ (J., L ,'GlCo , who is personally known to me or ha3 tJl "c1w:ed 41i: ielel,tifiOl!:ll1un-and who did take an oath. ....~~ PATRICIA A. COURTNEY !.'fW'~ Commission DO 707766 ~~ :,;i Expires September 19, 201.1. . #'4;. BondedThruTIllVFainl__~' ~~ IASII_l, GL kjNotary Public The annual registration fee is $25.00 per Lobbyist, according to Collier county 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# 007097620 8/9/2010 3:42:28 PM Dwight E. Brock Clerk of the Circuit Court @v~iD@D([jD ~@@@D~Q Customer CAROL A. L1CKO HOGAN LOVELLS, US, LLP 1111 BRICKELL AVE STE 1900 MIAMI, FL 33131-3142 Deputy Clerk BMR CASHIER M inutesand Records@CollierClerk.com 239-252-2646 Clerk Office Location Collier County Govt. Center Building F, 4th Floor 3301 Tamiami Trail East P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY 1 DESCRIPTION BMR Lobbyist Registration UNIT COST $25.00 TOTAL AMOUNT DUE: Check# 7062 BALANCE DUE: AMOUNT $25.00 $25.00 ($25.00) $0.00 [};@UUO@lj[};U(%J!1[%0 @@[JfJf) Page 1 of 1