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2012/2013 Collier County Clerk of Courts Expires 1 240 .J 3299 Tamiami Trail E. (Clerk's ffice only) Suite 401,Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name D c - s L \-4 CX Date f f - 1 Business Name Lezvu CO Business Address ?•0. Q c . cc. City ( r ca.fJ lid 5- State FL Zip Code 3 L3 Business Telephone g‘® (p l .t565- Contact Person Lobbyist E-mail C.c )c C --C 1,. 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*_--031411k C LIENT/ENTITY REPRESENTED: 1.Name erc ame Address Address 6113' Li". SE_.c-t- Z Code 33903-City t City (1�y�('s Zip Code 3.Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier- O.4 ( Lobby t.ig ature his registration was sworn(or affirmed) and subscribed before me this i day of, a , 20 I by \ 05 4ersonally Known Produced ID 4 ,,sri ,, KATHY L CREAMER D uty ' erk/Notary Public Type of ID Produced Notary Public-State of Florida My Comm.Expires May 10,2013 ,3fi sd= Commission N DD 888078 Bonded Through National Notary Assn. ^^ Receipt# 007283417 10/4/2012 2:33:10 PM ;,:k<„ Dwight E. Brock ` Clerk of the Circuit Court �l t _ yr' \k ©ffffi ai�c _ \ / — ����- Customer Deputy Clerk Clerk Office Location DANIEL H. COX BMR CASHIER Collier County Govt. Center DANIEL H. COX, P.A. MinutesandRecords @CollierClerk.co Building F, 4th Floor ATTORNEY AT LAW m 3299 Tamiami Trail East, Suite PO BOX CC 239-252-2646 401 CARRABELLE, FL 32322-1229 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# 11228 ($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. gglilEGITgli®ITBZoggral Page 1 of 1