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2012/2013
Clerk to the Board, Minutes &Records Dept. Expires 1 '� 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Douglas W. Nelson Date 7/11/2013 Business Address 1185 Immokalee Rd. Naples, FL 34110 239-415-2054 douglas.nelson @everbank.com Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1) EverBank, FSB 1185 Immokalee Rd. Naples, FL 34110 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) 7 /2/ Lob yi• gnature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this day of_jc)jA.J , by j,1 _A ,2x1,, who is personally known to me or has produced as identification and who did take an oath. BETH ANN KOSTENO ti NOTARY PUBLIC L tof STATE OF FLORIDA BY L� ..� -I' _AO rt , .:: �� Commit EE868778 3/22/2017 DGputy- lerk/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, Ordinance 2007-24 and Ordinance 2013-39. Please make payment to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts and mail to the address listed at the top of the form. Receipt# 007364865 8/5/2013 2:26:18 PM g7.-61',1 :i;,,,,,- Dwight Dwight E. Brock Clerk of the Circuit Court i�'. 1 r,F,,ht ti p~. ©Elic„---_,- - D< 1 �� I N Customer Deputy Clerk Clerk Office Location DOUGLAS NELSON BMR CASHIER Collier County Govt. Center EVERBANK FSB MinutesandRecords @CollierClerk.co Building F, 4th Floor 1185 IMMOKALEE RD m 3299 Tamiami Trail East, Suite NAPLES, FL 34110-4804 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#207804 ($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. 0®000W @IllQggo IM Page 1 of 1