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2012/2013 Collier County Clerk of Courts Expires J2 (3 3299 Tamiami Trail E. (cie once only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM rai,D__ Name L V Z& M e T Date/� Business Name I`c`'+ &, /��"-ezle/ ' Business Address g'._<-0 i1ft .�''('�. i'J-e J City �� State F� Zip Code y��2-3 Business Telephone „239 -6-w-‘„g0-0 Contact Person S�-4-el, ii/f. 'Clik Lobbyist E-mail S1a Ike r a 1 c,L1 , COW, Notice for Lobbyists: The annual registration fee is$25.00 ner 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 I)ai4cw 2. Name 641. .M.2,-('S� C�c )6-‘ 1 -1'+L a . Address ' s ,I i 1!`-.r: ess City ff. M Zi f Code 337 13 City Zip Code 3. Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) CIO:, r.--€A State of Florida County of Collier b i t Signature This registration was sworn(or affirmed) and subscribed before , e this I ' ' day of, ; 20 , by , ■-t , , , S ' Personally Known BY: -(\,--- `. Produced ID Deputy Clerk/Notary Public Type of ID Produced 11A':`•*A.*- TRINASHATTO - Revised:08/2011 *: (r0-,` :* MY COMMISSION#DD 900793 Nill - EXPIRES:June 21,2013 1,1r 1% `, Bonded Thru Notary Public llnderwrters 850 PARK SHORE DRIVE TRIANON CENTRE-THIRD FLOOR ROETZEL & AN D RE S S NAPLES,FL 34103 239.649.2718 DIRECT 239.649.6200 MAIN A LEGAL PROFESSIONAL ASSOCIATION 239.261.3659FAx sfalk@ralaw.com www.ralaw.com September 12, 2012 Collier County Board of County Commissioners Minutes and Records Department 3299 Tamiami Trail East, Suite#401 Naples, Florida 34112 Re: Collier County Lobbyist Registrations Dear Sir/Madam: Enclosed is a firm check in the amount of $25.00 for the fee to cover my Lobbyist Registration (Steven M. Falk) for representation of Valencia Lakes at Orangetree Homeowners' Association, Inc. before the Board of County Commissioners as of this date for 2011-2012. Also enclosed is the signed Lobbyist Registration Form. Thank you for your assistance. Very truly yours, ROETZEL& ANDRESS Steven M. Falk For the Firm IMF Enclosures 6551724 Any federal tax advice contained herein or in any attachment hereto is not intended to be used, and cannot be used, to (1) avoid penalties imposed under the Internal Revenue Code or (2) support the promotion or marketing of any transaction or matter. This legend has been affixed to comply with U.S. Treasury Regulations governing tax practice. NEW YORK CHICAGO CLEVELAND TOLEDO AKRON COLUMBUS CINCINNATI WASHINGTON,D.C. TALLAHASSEE ORLANDO FORT MYERS NAPLES FORT LAUDERDALE Receipt# 007278400 9/14/2012 2:53:07 PM ,,; 01A \ Dwight E. Brock `2 �: Clerk of the Circuit Court • II CA t- 0 ET-c- - _°_),(e_Dyc(c Customer Deputy Clerk Clerk Office Location STEVEN M. FALK BMR CASHIER Collier County Govt. Center ROETZEL & ANDRESS MinutesandRecords @CollierClerk.co Building F, 4th Floor 850 PARK SHORE DR STE m 3299 Tamiami Trail East, Suite 300 239-252-2646 401 NAPLES, FL 34103-3587 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# 953976 ($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. ©CD[1[11U Vh ❑@CDC Page 1 of 1