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2013/2014 Clerk to the Board, Minutes & Records Dept. Expires 8 a L j 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 Jason Hunter Korn Date 06/25/2014 Business Address Cohen & Grigsby, P.C. 9110 Strada Place, Suite 6200, Naples, FL 34108 Business Telephone 239.390.1900 E-Mail jkorn @cohenlaw.com NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Cohen & Grigsby, P.C. 9110 Strada Place, Suite 6200 Naples, FL 34108 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) CC/ 44''‘ bbyist Signature State of Florida County of Collier The foregoing registration was sworn to nd subscribed before me on this day of ,jt.;ir--Nt j 1 y , bye z \ vfi...- o is personally known to� me or has produced as identification and who did take an oath. ;4,pY ry�c S� E sHaDoN ' 4 R ,." ti. MV COMMISSION 11 FF 015837 S By: .x./ 2 a ��..a ' EXPIRES:September 7,2017 ",7 ;d,`'' &lured Thru Notary Public undetwrite� Deputy Clerk/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# 007463579 6/27/2014 8:55:17 AM ���<<»; Dwight E. Brock Clerk of the Circuit Court Customer Deputy Clerk Clerk Office Location JASON H. KORN BMR CASHIER Collier County Govt. Center COHEN & GRIGSBY, P.C. MinutesandRecords @CollierClerk.co Building F, 4th Floor 9110 STRADA PL m 3299 Tamiami Trail East, Suite NAPLES, FL 34108-2396 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#6934 ($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. ©©l] IllQ 11® o @O 1CU Page 1 of 1