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2012/2013
Board Minutes & Records Expires 2013 3301 Tamiami Trail East Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name tL\c)ctS IhfLctiL Date k.9,` 17 -\2 Business Address 22.5 E. C,1, 5<4 '.\ S4'- 5-c 1-f' Co c.,U ©v c--c))) FL 3Z6V Business Telephone 4C1T - 6+4--` o E-Mail i/l j V ( C(c 1Ic,4:-71,4,,/,-, Cv '''` NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). 2,2 S,dc�v.-k Cy'cI,-I— Cc)>v ,`cvi S -2 PciA. Ev. tjcti f c4- t-Jc-V . TX 2). 4/PLEASE ATTACH ADDITIONAL SHEETS IF NECESS Y Lobbyist Signature State of Florida County of Collier The foregoing registration, sworn to and subscribed bef.re me on this i i � day of Vle__O,dh ��'oY i ' .i .G. . J' -.. 0 is pe . ; . me or has produced as identification and who did take an oath. KIMBERLY C.MATHENY - ' NOTARY PUBLIC �� STATE OF FLORIDA c bob- Me _� &$ i�af�l'� -•our-0 Comm#EE221303 -.__ • "' ' Deputy Clerk/Notary Publ c Expires 9/5/2016 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# 007304954 1/2/2013 10:05:43 AM ,,l,�a�Q.i. Dwight E. Brock �/ „ (- .- Clerk of the Circuit Court K.,,,,,_ 2j` rP o a ii- c a o :pc c-,2 - m ED__, (2,--,„ Customer Deputy Clerk Clerk Office Location NICHOLAS VANHOOK BMR CASHIER Collier County Govt. Center MCCALLA RAYMER, LLC MinutesandRecords @CollierClerk.co Building F, 4th Floor 225 E ROBINSON ST STE 660 m 3299 Tamiami Trail East, Suite ORLANDO, FL 32801-4321 239-252-2646 401 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# 1039 ($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. ©0lil0I@k@ggn Page 1 of 1