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2015/2016 Clerk to the Board, Minutes &Records Dept. Expires C-31(21, 0 3299 Tamiami Trail East, Suite #401 (Staff use only Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM NameAlan M. Mandel Date 06-02'2016 Business Address 10075 Bavaria Rd Fort Myers , FL 33913 Business Telephone 2397682900 E-Mail amandel@goodwheels.org NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Good Wheels, Inc. 10075 Bavaria Rd Fort Myers, FL 33913 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECE SARY) Lobbyist Signature 11 State of Florida yb{-a �a•:� lob�� SrT— -{�`� County of Collier r t;;13,z444.A.PICe.,..t.t . "4- The fore oing registration was sworn to and subscribed before me on this day of , by /6 , who is personally known to me or h produced p2c,aas identification and who did take an oath. Ark% CLAUDIA JANE SCHOLL ENBERGER h *: MY COMMISSION M EE 867613 7 r W...;;„,...., EXPIRES:April 22 2017 BY: vi ��°� /J , fi;•' Bonded Tru Not, PublcUndecwriters Deputy Clem otary 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. I\CVC11/1./t VVI VV IJJV 6/9/2016 10:44:16 AM , �:�,�.., Dwight E. Brock %;;„� �._ \�,, Clerk of the Circuit Court 1 \ \71'#t C1tiikvcor o<;_„. �@(, ) TR Customer Deputy Clerk Clerk Office Location ALAN M. MANDEL BMR CASHIER Collier County Govt. Center GOOD WHEELS, INC. MinutesandRecords@CollierClerk.co Building F, 4th Floor 10075 BAVARIA RD m 3299 Tamiami Trail East, Suite FORT MYERS, FL 33913-8515 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# 37370 ($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. ©©QQD®C'@h ❑ c@goj] Page 1 of 1