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2011/2012 Collier COlinty Clerk of Courts 3299 Tamiami Trail E. Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 Expires BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name E>j:\iZ~Y ~Yj2E.J Date 10 l1:.J /I Business Name .JOHu~oJJ ErJ6n.JeE2-.,ucrl ItJG. Business Address 2?~o ""STA.j FQ{2.1) Code.. T Zip Code 34 112- City I'J kpLES State F L Business Telephone 434-033..3 Contact Person Lobbyist E-mail bsyre.(\@ jOhr1.5ollc-nq. LOrYJ Notice for Lobbvists: The annual registration fee is $25.00 oer Lobbvist, per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock. Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: of::> e e @ 1~tQd1elJl 1. Name 2. Name Address Address City Zip Code City Zip Code 3. Name 4. Name Address Address City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY) City Zip Code State of Florida County of Collier ~ ~'-' Lobbyi ~$ignil4!re This registration was sworn (or affirmed) and subscribed before me this OetopiJv , 20-.lL, by -s.~ .s~AMu ( ~-- ~ Personally Known cBY: Produced ID Type of ID Produced NOTARY PUBUC-STATE OF FLORIDA ....'......",';. Patricia 1. Romano ~ W 1 Cc~missioo # DD84390S ',....!.~..,.. Explfes: Jft..N. 23, 2013 BONDED THRU ATLANTIC !lONDING CO.. L'iC. ~ / ~.,. day of, Revised: 08/2011 Receipt# 007199026 11/1/2011 11 :21 :30 AM /0. \~'\'J{'f-IJ;-' /<.."'- ..... \';!~ Dwight E. Brock Clerk of the Circuit Court I,,::,!, 1 ' ,:~: ~; ."~::",, r,,/ fIll ll\to.. ,\' ~ -c ':"1 --~ - ,----- - ,,/i_. - - '- ~ ---' -" '- L_. ~_ .~~~__ Customer BARRY SYREN & JARED BROWN JOHNSON ENGINEERING, INC. PO BOX 1550 FORT MYERS, FL 33902-1550 Deputv Clerk BMR CASHIER Minutesand Records@CollierClerk.co m 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# 18547 BALANCE DUE AMOUNT $50.00 $50.00 ($50.00) $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. @@DD~@U@D@~@@(]iJi) Page 1 of 1 , o 1.0"'" C'\I N M N '<t '<t ; ~ 8 ~ ;~ 8 C"") .....J ,.... 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