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2011/2012 Collier County Clerk of Courts Expires Ye:720/(9 3299 Tamiami Trail E. (Clerce only) Suite 401,Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name DavId R.. UnclexhilA tJr. Date Ip`ZO/11 Business Name SC 1,111(-5 all I flt. e-V1 r9 Business Address 105 I I S 1X NI U-& ""!(X'S5 PaArlaJJaA.l City Pt, 1149-e)16 State rt, Zip Code 3 3040(0 Business Telephone 2.3 -64 361-541 O Contact Person Jen h 1' V S ppw'v1 Lobbyist E-mail d (,Inct eivyluik_bank send. (,gym Notice for Lobbyists: The annual registration fee is S25.00 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 COl1t-e;r Co. LOrYwrl Redcv 2. Name eOvyshovG 4a-GWOIt( Trtangtci AgtncA4 Gomm . Redcv• AojehGy Address 3301 E.Tam i am fl 0 I Address 40(0'1 Ba ShOve, Dr v e City Niaples Zip Code 3411Z. City Nap 1,es Zip Code 34112.. 3. Name Thi p t 72 bt,1i Co M P(,l,n lWS 4. Name Address TWO 1'7 rvhfa Plaza Ste 8'OO Address City CiOOU,YVII'2US Olto Zip Code 432 LS City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida _- County of Collier Lobbyist Signature This registration was sworn(or affirmed) and subscribed before me this day of, Oeithrv, 2011 , by avid R Lt.nc4'c11Lit f. ./Personally Known :9& i . 1 UffiCL Produced ID t! Deputy-Clerk/Notary 'ublic Type of ID Produced ,tvgr eiN.,, JENNIFER M.SHEPPARD MY COMMISSION#DD 908207 EXPIRES,N vIO;bl3r 16 2013 rty, Bonded Thnl Nary Public 11 envnters Revised:08/2011 Receipt# 007200728 11/8/2011 8:15:55 AM Dwight E. Brock • Clerk of the Circuit Court Customer Deoutv Clerk Clerk Office Location DAVID R. UNDERHILL, JR.; BMR CASHIER Collier County Govt. Center JONATHAN HAGAN; DEAN S. MinutesandRecords @CollierClerk.co Building F, 4th Floor ZIEGLER; TODD R. REBOL m 3299 Tamiami Trail East, Suite BANKS ENGINEERING 239-252-2646 401 12653 SW COUNTY ROAD P.O. Box 413044 769 STE B Naples, Florida 34101-3044 LAKE SUZY, FL 34269-5907 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 4 BMR Lobbyist Registration $25.00 $100.00 TOTAL AMOUNT DUE $100.00 Check# 17501 ($100.00) 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. Coaaa®moo® ©oli[fa Page 1 of 1