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2016/2017 Collier County Clerk of Courts Expires D492017 3299 Tamiami Trail E. (Clerk's ffice only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Lobbyist Name Brian O. Cross, Esq. Date September 16, 2016 Business Name Goese, Adamczyk,DeBoest&Cross, PLLC Business Address 8950 Fontana Del Sol Way, First Floor City Naples State Florida Zip Code 34112 Business Telephone (239) 331-5100 Contact Person Brian O. Cross, Esq. Lobbyist/Contact E-mail bcross@gadclaw.com Notice for Lobbyists: The annual registration fee is$25.00 per Lobbyist,per Collier County Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Payments made out to: Collier County Clerk of Courts or Dwight E.Brock, Clerk of Courts(ADDRESS ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name Vaguna Corporation 2.Name Beach Box Cafe, LLC Address 9155 Gulf Shore Drive Ste 402 Address 9020 Gulf Shore Drive City Naples Zip Code 34108 City Naples Zip Code 34108 3.Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) _.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.. .._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._ it State of Florida County of Collier AlfAd Lobbyist S'1 ature This registration was sworn(or affirmed) and subscribed bee thi \S h day of,S e.e'le mbe C 20119 ,by jc o y- O .Cc'OSS V Personally Known BY: <'( R`.0-- n Produced ID Deputy Clerk/Notary Public Type of ID Produced moo, ;P„e� UURAC.STEADMAN * t_� * MY COMMISSION#FF 145837 nu EXPIRES:July 28,2018 0, rAreoF fop.e Bonded Thru Budget Notary Se ices. Kevised:08/2014 rwualNrm wt r r•raw 9/20/2016 2:37:22 PM �,t,,,,,,,r Dwight E. Brock Clerk of the Circuit Court ifs i1+t � , ii K � .._ J Customer Deputy Clerk Clerk Office Location BRIAN O. CROSS, ESQ. BMR CASHIER Collier County Govt. Center GOESE, ADAMCZYK, MinutesandRecords@CollierClerk.co Building F, 4th Floor DEBOEST, CROSS, PLLC m 3299 Tamiami Trail East, Suite 8950 FONTANA DEL SOL 239-252-2646 401 WAY STE 100 P.O. Box 413044 NAPLES, FL 34109-4420 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# 15419 ($25.00) I 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. ©®Q011@Q@gOo Page 1 of 1