2011/2012 Collier County Clerk of Courts Expires �/-
3299 Tamiami Trail E. (Cl k's office only)
Suite 401, Bldg. F,4th Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Todd R. Rebol, P.E. Date 10/27/11
Business Name Banks Engineering
Business Address 12653 SW County Road 769, Suite B
City Lake Suzy State Florida Zip Code 34269
Business Telephone (941) 625-1165 Contact Person Todd R. Rebol, P.E.
Lobbyist E-mail treboljubankseng.com
Notice for Lobbyists: The annual registration fee is 825.00 per Lobbyist, 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:
1. Name Collier County Community 2. Name Bayshore Gateway Triangle Community
Redevelopment Agency Redevelopment Agency
Address 3301 Tamiami Trail East Address 4069 Bayshore Drive
City Naples Zip Code 34112 City Naples Zip Code 34112
3. Name The Pizzuti Companies 4. Name
Address Two Miranova Place, Ste. 800 Address
City Columbus, OH Zip Code 43215 City Zip Code
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of Florida %Ii°44111111.°:
County of EellierDesoto
Lob r yist Signature
This registration was sworn (or affirmed) and subscribed before me this 27th day of,
October , 20 11 ,by Todd R. Rebol, P.E.
X Personall Known r
Personally , n�, HEATHER L.^• i7• L� L -1 '`,
Produced ID o<� ''- Notary Public-State of Florida •eputy Clerk/Notary Public
Type of ID Produced N/A ( _, My Commission Expires Jan 8,2012
,, Commission# DD 746989
-"gip„u-,: ' Bonded Through National Notary Assn. Revised:08/2011
Receipt# 007200728
11/8/2011 8:15:55 AM
;1t Dwight E. Brock
Clerk of the Circuit Court
•
Customer Deputy Clerk Clerk Office Location
DAVID R. UNDERHILL, JR.; BMR CASHIER Collier County Govt. Center
JONATHAN HAGAN; DEAN S. MinutesandRecords @CollierClerk.co Building F, 4th Floor
ZIEGLER; TODD R. REBOL m 3299 Tamiami Trail East, Suite
BANKS ENGINEERING 239-252-2646 401
12653 SW COUNTY ROAD P.O. Box 413044
769 STE B Naples, Florida 34101-3044
LAKE SUZY, FL 34269-5907
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
4 BMR Lobbyist Registration $25.00 $100.00
TOTAL AMOUNT DUE $100.00
Check# 17501 ($100.00)
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.
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