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2013/2014 Collier County Clerk of Courts Expires ( (2o4' 3299 Tamiami Trail E. (Clerks office only) Suite 401, Bldg. F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM -----4-q- get= g� Name / //�s i-L '/`L Date r// L3 Business Name LAW OFFICE OF Business Address DOUGLAS L RANKINI MOOKINGS PROFESSIONAL BUILDING 35 TAMIAMI TRJ,?L.NORTH SUITE 308 City NAP[F FLSj$#3 Zip Code Business Telephone 2 371 ?62_006/Contact Person vim'//...1 /' 42 Lobbyist E-mail C/,---7_ 7.---t 4 = 4 /'min, E G-e z2j Notice for Lobbyists: The annual registration fee is 525.00 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: 1.Name �G r _((5 r��� 2. Name ) j e")6c ,1.,„-2,Fz7 Address O—Yt "-i ' / Address / 7 S4,, wS�C6 City Co City rZ' �ZI:9 Zip Code qi/f 3. Name 6-e-1-20-41-g-t-e.- OC©/,r4 Name ,� O if...L....., Address I V -u,--z� C� Address I � City v t, L `�r7 Zip Code `` City L�� Zip Code 3711 V (ATTACH ADD ONAL CLIENT SHEETS,IF NECES ARY) State of Florida County of Collier Lobbyist Signature is registration was sworn(or affirmed) and subscribed before me this , h k �� day of, /fs , 20/3 , by JDU6 ,S 6., 2,1iUK (ti' Y f i . Personally Known B : f/',_..!,4 � ,4 / _ ' Produced ID De su Cler . y Public Type of ID Produced CAROL A.LEUSCFIER I*:. A h %.:,4 MY COMMISSION#DD 992074 d•. .q EXPIRES:June 15,2014 Revised:08/2011 Rf h� Bonded T ru Notary Pubik Undeir�ltee Receipt# 007367434 8/13/2013 1:40:40 PM f-ti,!�<<�� ,r Dwight E. Brock Clerk of the Circuit Court l � 1 fi' < ` n ED)FTh n 0 Customer Deputy Clerk Clerk Office Location DOUGLAS RANKIN BMR CASHIER Collier County Govt. Center LAW OFFICE OF DOUGLAS L. MinutesandRecords @CollierClerk.co Building F, 4th Floor RANKIN m 3299 Tamiami Trail East, Suite 3225 TAMIAMI TRL N STE 308 239-252-2646 401 NAPLES, FL 34103-4106 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# 11590 ($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. V®1]D11 QTglQ @CM Page 1 of 1