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2014/2015 Collier County Clerk of Courts Expires_f_ti?50 J 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 I ' `1 ' ' 'I4 ' Date el- Z°l L� Business Name m 14A 1"-s P O E T AT I (7 Business Address 76 1 2i sT nAti City /JA i 1 E 5 State f- - Zip Code I/ Z O Business Telephone(2. 1) Ii ti" 2.76 /Contact Person Lobbyist E-mail 3(1 3'' { e SH' co, 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 \L of CDS 2. Name Address"I D-3 1 ) ' l f.2 A irt-Pcfx, Address City_ g 611k- Zip Codeaf City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier L,i7 ist Signature l'fl"re 'stratio as swo affirmed) and subscribed before me this day of, u. , 20 � , by<U, Personally Known BY )- � , '/ Produced ID Deput Cle','. 'otary Public Type of ID Produced 1t. Revised:08/2011 Receipt# 007475130 8/7/2014 8:55:53 AM Dwight E. Brock Clerk of the Circuit Court gffg_ Customer Deputy Clerk Clerk Office Location JIM BANKS BMR CASHIER Collier County Govt. Center JMB TRANSPORTATION MinutesandRecords @CollierClerk.co Building F, 4th Floor ENGINEERING m 3299 Tamiami Trail East, Suite 761 21ST ST NW 239-252-2646 401 NAPLES, FL 34120-1813 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# 2223 ($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©CDUE ° T0�dh❑gg Lf if Page 1 of 1 III t k' Collier County Clerk of Courts Expires V . 1 3299 Tamiami Trail E. (Clerk s office only) Suite 401,Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS' LOBBYIST REGISTRATION FORM r Name JM gii iv;S S Date "" ?- 2o) S Business Name J/VI'Q 1 AA NSPbX rnTJ o."-) 6N6 . Business Address 74 I Z I SF S J A)V") City N/7 f L ES State r L Zip Code . 4 ) z v Business Telephone 231 / II z7 7Contact Person i J✓ 1 B4'�Xs Lobbyist E-mail \,)/11 12S -6 e e M .N. CV''7 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/F,NTITY REPRESENTED: 1.Name A1L60 '"M 4''/11 E 2. Name VA(`n ) E.C. Address Address City Zip Code City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida } County of Collier ''r L �, Ist Signature ootttuttior,s This registration s sworn r affi ed and subscribed before me this r -`-'L.!"ay`of,'.� ---,, 20 1D, by sworn �S d s` Personally Known BY 51 t 4 6 c=x x Produced ID Depu Cl. r`t,`o3.try-Pub1is : t., ' 4 r..., Type of ID Produced IQ IIC • o ,. . r /,, -Revp r d.'O,00411 r !!-!?,I.:114'11' �A I1CL.GIt.J Lit V V!JJV I V 1 5/7/2015 12:21:51 PM ,,,� t<<,;; Dwight E. Brock �� l Clerk of the Circuit Court h Customer Deputy Clerk Clerk Office Location JIM BANKS BMR CASHIER Collier County Govt. Center JMB TRANSPORTATION MinutesandRecords @CollierClerk.co Building F, 4th Floor ENGINEERING m 3299 Tamiami Trail East, Suite 761 21ST ST NW 239-252-2646 401 NAPLES, FL 34120-1813 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 Cash Tendered ($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. ©0[1[117 ° h ❑@OREla Page 1 of 1