2012/2013Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
Expires ql2or)' -
(Cler s office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name N'4 k% - Date /0 0 ?
Business Name
Business Address
City State _
Business Telephone 213q l
Lobbyist E -mail
Contact Person
Zip Code
ct-e _j t"' AZ'I 14� I--
Notice for Lobbyists: This annual registration fee is $25.00 per Lobbyist, pelr 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 CLIENVENTITY REPRESENTED:
1. Name E �) V6ftlkl 2C lame
Aq*ess Z��f ,� "� 9-4 k4 Address
City (!/ J Zip Code Y1615 City
3. Name
Address
4. Name
Address
City Zip Code City
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
State of Florida
County of Collier
Lobbyist Siguailure
r
This registration was sworn (or affirmed) and subscribed before me this
201x, by N ,`4 A - ?Pr-,4TUN.
Personally Known
Produced ID
Type of ID Produced f 350 ba( Li9)-4t9 0
Zip Code
Zip Code
INA) .1. day of,
Public
My Comm(,Expires May 8. 2015
Commission # EE 91446
Bonded Through National Notary Assn. Revised: 08/2011
Receipt# 007283416
10/4/2012 2:31:38 PM
Dwight E. Brock
Clerk of the Circuit Court
V
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k�y
Customer Deputy Clerk Clerk Office Location
NANCY A. PAYTON BMR CASHIER Collier County Govt. Center
FLORIDA WILDLIFE MinutesandRecords @CollierClerk.co Building F, 4th Floor
FEDERATION m 3299 Tamiami Trail East, Suite
2590 GOLDEN GATE PKWY 239 - 252 -2646 401
STE 105 P.O. Box 413044
NAPLES, FL 34105 -3204 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# 3573 ($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.
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Martha S. Vergara
From: Nancy Payton <nancypayton @fwfonline.org>
Sent: Wednesday,January 02, 2013 6:12 AM
To: Martha S.Vergara
Subject: Lobby Update
Hello Martha,
I am still representing only Florida Wildlife Federation before the Collier Commission.
Happy 2013!
Nancy
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Martha S. Vergara
From: Nancy Payton <nancypayton@fwfonline.org>
Sent: Wednesday, April 03, 2013 9:53 AM
To: Martha S.Vergara
Subject: RE: Lobby Update
Hi Martha,
Ooops, I am late.
I am still representing Florida Wildlife Federation and only Florida Wildlife Federation
as a paid representative.
Happy Spring!
Nancy
Nancy A. Pawon
Florid.; Wildlife Federation
2590 ( olden Gale Parkway#105
Naples Florida 34105
239-784-5119