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2013/2014 Clerk to the Board, Minutes&Records Dept. Expires 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Blair A. Foley, PE Date 12/3/13 Business Address 120 Edgemere Way South, Naples, FL 34105 Business Telephone 239.263.1222 E-Mail fols000@aol.com NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1) Boys & Girls Club of Collier County - 7500 Davis Blvd., Naples, FL 34104 2) Various other Clients (PLEASE ATTACH ADDITIONAL SHEETS,IF NEC'SSARY) „<ez `Lor bbyist Signature State of Florida County of Collier The foregoin registr4tion was swocn to and_s u)scribed before me on this �U day of by <&r 1 v,t , who is personally known to me or has produced -�C- LL. r as identification and l who did take an oath. / gotY► Notary Public State of Florida A1 BY: Paula J Brethauer Ex.! 16/1512014 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# 007400146 12/3/2013 12:56:36 PM Dwight E. Brock Clerk of the Circuit Court tir Customer Deputy Clerk Clerk Office Location BLAIR FOLEY BMR CASHIER Collier County Govt. Center BLAIR FOLEY MinutesandRecords @CollierClerk.co Building F, 4th Floor 120 EDGEMERE WAY S m 3299 Tamiami Trail East, Suite NAPLES, FL 34105-7107 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#8626 ($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. ©®EllilO®TCO®GgOm Page 1 of 1