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2011/2012 Collier County Clerk of Courts Expires / �/� 3299 Tamiami Trail E. (Cler s office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name L .p c L . r o A A,c C �- Date - 30 - / V r Business Name Col e,an lay c,AOJ�h � KwPckr PA . Business Address 1O ak,,A; ( TN . I t). ) Su. 3 0 0 City Nc4t 5 State FL Zip Code 3 `(103 Business Telephone P3 Q1-1135-35 35- Contact Person Ci'ec r b N c C Lobbyist E-mail qti■c ba ® cy ktc,, ;rrN,cow-, Notice for Lobbyists: The annual registration fee is$25.00 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: RESENTED: / 1.Name RU-S oc No.etes, Inc . 2. Name f lei Are�. Pr. c.rc 0-F /?ec,(1�i3 Address (4s5 PocJi Address LLI SS e e•die_ City NI Zip Code 3'11111 City Na files Zip Code 3 WW 1 3. Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida 146 County of Collier L•■•• Lob. ' •Igna urea This registration was sworn(or affirmed)and subscribed before me this 2k day of, OCR"' ,2031,by .e, L UJ . Personally Known BY: 4ore/o C.,SCRA Produced ID - - - - - - - -1 p'f"r�rkfNotary Public Type of ID Produced 4 " KAREN C.STEVENSON ( ae tres= Notary Public-State of Florida 5 My Comm.Expires Oct 14,2013 '9 ( Revised:OB/2011 Commission#OD 919984''FOr;�'' Bonded Through National Notary Assn. Receipt# 007195610 10/17/2011 3:37:09 PM - R( Dwight E. Brock tis 5 U(S',\ Clerk of the Circuit Court ao 0 0_ j2,__,L__ _:-___7-- F' FD Customer Deputy Clerk Clerk Office Location GREG URBANCIC BMR CASHIER Collier County Govt. Center COLEMAN, YOVANOVICK & MinutesandRecords @CollierClerk.co Building F, 4th Floor KOESTER, P.A. m 3299 Tamiami Trail East, Suite 4001 TAMIAMI TRL N STE 300 239-252-2646 401 NAPLES, FL 34103-3591 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check#21461 ($25.00) 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. ©DDD11QT@OQ gOED Page 1 of 1