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2011/2012
Collier County Clerk of Courts Expires 0201�� 3299 Tamiami Trail E. (Clerk's ftice only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name JOna- hat 1-1.alar1 Date 1012-0111 Business Name 13a.n Ks Eng l nec rl rN■ Business Address 105 it S l i Ivki..te CAI press Pates a i City Ft. CYIt e,YS State FL Zip Code 33010(0 Business Telephone 2301-130- 4°I C Contact Person Jenni-f-er Sheppard Lobbyist E-mail I halal vi @ bartiG5erto, co YV1 Notice for Lobbyists: The annual registration fee is 525.00 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 0)11 f�S:v'CO. (,OYYIm . Kean/. 2. Name ~""1 SI v r� E1A,{ �I G Acn�4. , . amyl • gedcVh iwycnai Address 3301 E•I A.VY1 tai ii Tircui Address 401001 gall shove. Drive. City tJ1144eS Zip Code 34112 City NapteS Zip Code 'i l Z 3. Name The P►azufi CDmpanics 4. Name Address TIAN VIA tranovtx Piaui S{c g0° Address City COL L/1419 S 1 OH10 Zip Code*3 2.15 City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida / County of Collier ,Ada Lobby V.i �a' r This registration was sworn (or affirmed) and subscribed •efore me this 2 0 day of, Oc be4- , 201__, by ■-)DfcLitaii idrifittin ✓ Personally Known B mE4 tilLgi, Produced ID ` �;� ` JENNIFER M.SHEPPARDIF )eputy lerk/Notary Public Type of ID Produced =*: `,*, MY COMMISSION it DD 908267 •, ,.;o- EXPIRES:November 16,2013 -1. �,V Bonded Thu otary Public Underwriters i ` Revised:08/2011 Receipt# 007200728 11/8/2011 8:15:55 AM Dwight E. Brock Clerk of the Circuit Court „)), hi ciK 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. ©01:11MQII©IiiQ @CDED Page 1 of 1