Loading...
2012/2013 Collier County Clerk of Courts Expires 2"/✓ 3299 Tamiami Trail E. (Clerk's office only) Suite 401,Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name 1 t 5Q4'vle S N 6--t.01 ce Date l (9 (2 c 13 Business Name A't cf oc* (-1(t n Ora-i @, -(�j p�,Sn►�1 1 g Business Address a70 A\fey ACC\ City State I Zip Code 1 Business Telephone •T( " 8 - 161.7 7 Contact Person (-� , t anCZLJ fiIJ( Lobbyist E-mail \.J I ii'N e imCg cli cej re)(.f. C-Orn 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: 1.Name c, 1GS V.(C6.Ci►''e_ 2. Name Address �=j tL'�Cp ;'� AA(e Address sue. <400 City ,T5c.,t-r- JO 1 K.1 Zip Code (4)._3,1 City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACI I,ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Fla ,01 County of e � " Lobby t Signature This registration was sworn (or affirmed) and subscribed before me this e -FY\ day of, Ja YW.ckni ,20 13 , by JGccouei re X Personally Known B C ; )(- nb )(2 Produced ID Ddlouty Clerk/Notary Public Type of ID Produced NA'S JACQUELINE A. LITTLE Notary Public,State of New York No.01L16098514 eviscd:08/2011 Qualified in Erie Count Commission Expires September 15,20P AIRPORT PULLING ORANGE BLOSSOM 560 Delaware Avenue, Suite 400 Buffalo, New York 14202 716-829-1977 fax 716-885-1319 January 9, 2013 Via: U.S. Mail Collier County Board of County Commissioners Minutes and Records Department 3299 Tamiami Trail East, Suite#401 Naples, Florida 34112 Re: Collier County Lobbyist Registrations 2012-2013 Dear Sir/Madam: Enclosed is my firm's check in the amount of $50.00 for the fee to cover the individuals representing our business and address before the Board of County Commissioners as of this date. Thank you for your assistance. Sincerely, //12.. L-" .. r Catherine A. Panczykowski Executive Assistant /cap Enclosures Receipt# 007307877 1/14/2013 3:17:13 PM ,,,x<-,,._ Dwight E. Brock G� A�I�. Clerk of the Circuit Court '''''Is'11—k 1 i.1_____10/ 0 Uff g 0 J Customer Deputy Clerk Clerk Office Location F. JAMES MCGUIRE & JAMES BMR CASHIER Collier County Govt. Center F. DENTINGER MinutesandRecords @CollierClerk.co Building F, 4th Floor AIRPORT PULLING ORANGE m 3299 Tamiami Trail East, Suite BLOSSOM, LLC 239-252-2646 401 560 DELAWARE AVE STE 400 P.O. Box 413044 BUFFALO, NY 14202-1212 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 2 BMR Lobbyist Registration $25.00 $50.00 TOTAL AMOUNT DUE $50.00 Check# 118 ($50.00) 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. ©©[1[1hTigkg[ ❑ grga Page 1 of 1