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2012/2013 Collier County Clerk of Courts Expires ��� 3299 Tamiami Trail E. (Cle 's office only) Suite 401, Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Torn Tippett Date 03/08/2013 Business Name Integra Realty Business Address 1061 Collier Center Way, Suite 9 City Naples State FL Zip Code 341110 Business Telephone (239) 641-3671 Contact Person Tom Tippett Lobbyist E-mail tom@tatippett.com 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 CLIENT/ENTITY REPRESENTED: 10 (-� � LLC State of Florida County of Collier e4d 1st Signa ure C�h This registration was sworn (or affirmed) and subscribed before me this 0 day of, )rs , 20 , by700\-7-cc;e Personally Known BY)- Produced ID Deputy C -rk/Notary Public Type of ID Produced �..• Y t JESSICA RAMOS i -X No1uy Public-Stale atone:•- My Comm.Ea i ss May IS 201nda $ 1 ;1 i Commbaies s EE INN1 � '' °; � $oa11111roa1A titliaatl Apa. /2011 . ZIN,AP QV6: . . wI ■r: . w1 e,« -2m m#mis § »:0.6 p :�<} :kwlA% _ l fAw . lt. :. 0ww ¥ , x _ Receipt# 007321758 3/11/2013 10:25:28 AM 011t(l)L.yl Dwight E. Brock Clerk of the Circuit Court ag ---- - 12 7 O j \ _4 _j9iQ Customer Deputy Clerk Clerk Office Location TOM TIPPETT BMR CASHIER Collier County Govt. Center INTEGRA REALTY MinutesandRecords @CollierClerk.co Building F, 4th Floor 1061 COLLIER CENTER WAY m 3299 Tamiami Trail East, Suite STE 9 239-252-2646 401 NAPLES, FL 34110-8403 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# 10011 ($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. • ©CA 1111®TgligTaLi C on Page 1 of 1