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2015/2016 Clerk to the Board, Minutes & Records Dept. Expires D Ito 3299 Tamiami Trail East, Suite #401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Reid Fellows Date 06/24/16 Business Addres52726 Oak Ridge Court, Suite 503 Fort Myers, FL 33901 Business Telephone 239-278-3090 E-Mail rcf@trtrans.net NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1) Racetrac 3225 Cumberland Blvd, Suite 100 Atlanta, GA 30339 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESS RY) Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this Q'- ' day of ko_ , by 2&c, frA I S , who is personally known to mc or has produced as identification and who did take an oath. 10DIANNA QUINTANILLA �.� :'_. MY COMMISSION t FF 051804 a•• EXPIRES:September 5,2017 BY: ^� --Ate Bonded Thru NotaryPublic Olden/rears �� `' (ALLA.L/l. �� l�� 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. 'ACV..GIFU? VVI VVI YVY 6/27/2016 3:43:11 PM Dwight E. Brock Clerk of the Circuit Court ffg- Customer Deputy Clerk Clerk Office Location REID FELLOWS BMR CASHIER Collier County Govt. Center TR TRANSPORTATION, INC. MinutesandRecords@CollierClerk.co Building F, 4th Floor 2726 OAK RIDGE CT STE 503 m 3299 Tamiami Trail East, Suite FORT MYERS, FL 33901-9356 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# 27751 ($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. ©00Diliara goy Page 1 of 1