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2010/2011 Board Minutes & Records 3301 Tamiami Trail East Building F, 4th Floor Naples, FL 34112 Expires ~ BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name +~k>t'\c10 f>ot\c.€. Date \-4 - 20\\ Business Address ~OOO '\.1. l\.~\.I1 1].-. l'Soih. lOll \~",~g j ~ L &3 C,Q"2. Business Telephone 8r~ 12.4 B~~L. E-Mail rtJo(\c.Q..~tl\k1tali"e,.c..o11\ NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: I). -It.sle.im!d U'\?,.~ C~ \..l~1t5.1 LLC. ~(o r\,-. 1)61\1 \6 -ro1T.eS 'LClx~ ~\sca)'{)e cJ-. .. Na~le.s rL ~1~'S 2). PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY Lote: State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this 4+ h dayof~Qn 020~\ ,bYJ:Obric.io P(')()r~ ,whoispe~wnto me or has produced tJ-A as I en 1 lcation and who did take an oath. I!'_"" SARAH J. RADER ~~ MY COMMmSION # DD1l93713 ~ EXP!IU'.S: May 27.2013 I~"RY Pl. Nolar1--. Co. BY: ~ ~ enck,... Deputy Cler otary Pubhc 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# 007130717 1/7/2011 4:13:59 PM Dwight E. Brock Clerk of the Circuit Court @flVD(~D~I] ~c~@@D~Q Customer WILLIAM E. OLIVER, FABRICIO PONCE TINDALE OLIVER 1000 N. ASHLEY DR,., SUITE 100 TAMPA, FL 33602 Deputy Clerk BMR CASHIER M inutesand Records@CollierClerk.com 239-252-2646 Clerk Office Location Collier County Govt. Center Building F, 4th Floor 3299 Tamiami Trail East, Suite 401 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY 2 DESCRIPTION BMR Lobbyist Registration UNIT COST $25.00 TOTAL AMOUNT DUE: Check# 4979 BALANCE DUE: AMOUNT $50.00 $50.00 ($50.00) $0.00 ~@o 0 D@[f~O@[fOJo @@[J[f[J Page 1 of 1