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2012/2013 Clerk to the Board, Minutes&Records Dept. Expires /cO I 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples,FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Morri 'Depew Assoc., Inc. Date 10/24/12 Business Address 2914 Cleveland Avenue Fort Myers, FL 33901 239.337.3993 sholland@m-da.com . Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). David W. Depew, PhD, AICP, LEED AP Morris-Depew Associates, Inc. 2914 Cleveland Avenue, Fort Myers, FL 33901 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) _ Pt Alibad - Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on th. day of C o)b1 by David W.Depew,PhD,RICP,LeedAP,who sersonally known me or has produced as le e • a ion and who idta e n . SHEILA M.HOLLAND a:��rr P M, _r� `��"�`'tr Notary Public`Mato�Florida I. My comet.E�coias SIP r,rata BY: - �,�.� V11),. commission•EE 123907 4 N,„, NAM Through Naomi Ivry AIM. Deputy Clerk/Notary Public The annual registration fee is$25.00 per Lobbyist,according to Collier County Ordinance No.2003-53,as amended by Ordinance 2004-05 and Ordinance 2007-24. Please make payment and mail to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts(at the address listed at the top of the form). Receipt# 007289740 10/31/2012 10:49:11 AM Dwight E. Brock ` ! Clerk of the Circuit Court Customer Deputy Clerk Clerk Office Location DAVID DEPEW BMR CASHIER Collier County Govt. Center MORRIS-DEPEW MinutesandRecords @CollierClerk.co Building F, 4th Floor ASSOCIATES m 3299 Tamiami Trail East, Suite 2914 CLEVELAND AVE 239-252-2646 401 FORT MYERS, FL 33901-6003 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#49737 ($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. ©O111:111QO(g@gn Page 1 of 1