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2013/2014 Collier County Clerk of Courts Expires j 44)1 3299 Tamiami Trail E. (Clerks office only) Suite 401,Bldg.F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Jaie.s T. I-cn-J L io 1��U Date 9 ) 5h2oI3 O Business Name IA �, ?` - �� Lll C� X J1 9.E,, LO S&Y)') Business Address 5 La) Z a r. ,e.. e ,/ s- . 400 City j.1,1 F -P-dl.X.�(.) State "�y Zip Code ILA C) �-- Business Telephone '7 1 -O t 91'"I q T - Contact Person Co-haute, L5 , Lobbyist E-mail jab/4 lciPil'--o l 4 C eta-1..'�I'��1 1+- C,Oro Notice for Lobbyists: The annual registration fee is $25.Q0 per Lobbyists per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name J F -lQ/ ,-I Ter- 2. Name Address 5(00 [ kt' Act' . Address City,( 1.Yy. Zip Code ) QL)a-- City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida-.f Q,tkYOY1L County of Collier e f _.e_jr .� Lobbyist S': I ature This registration was sworn (or affirmed) and subscribed before me this . S day of ,20" i 3 , by ._lames FT Per, Personally Known BY: Produced ID D4uty Clerk/Notary Public Type of ID Produced PHYLLIS E.LEWANDOWSKI Notary Public,State of New York Revised:08/2011 Qualified in Erie Co.,No.4835482 Commission Expires April 30.E j Receipt# 007383598 10/4/2013 2:34:59 PM L„..�,�,,. Dwight E. Brock /`�� Clerk of the Circuit Court i^\ A „b.), -\ :41:;/;$ `'l-ik:60-/` \,, 0D 0 _ .,____ ,___. , ` 0 / Customer Deputy Clerk Clerk Office Location JAMES DENTINGER BMR CASHIER Collier County Govt. Center AIRPORT PULLING ORANGE MinutesandRecords @CollierClerk.co Building F, 4th Floor BLOSSOM m 3299 Tamiami Trail East, Suite 560 DELAWARE AVE RM 400 239-252-2646 401 BUFFALO, NY 14202-1204 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# 166 ($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. ©dial®17©11®DtZoggial Page 1 of 1