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2017/2018 Collier County Clerk of Courts Expires 3299 Tamiami Trail E. (Clerk' Office Only) Suite 401, Bldg. F,4th Floor Naples, Florida 34112 COLLIER COUNTY LOBBYIST REGISTRATION FORM Lobbyist Name m 1 ► y+( i®N Date 7- 26- / 7 Business Name ( v A?iPS ,4c eA B0g� DP /)e s ( Aoij Business Address ! y 5- 5 r;,,,e, dye City 'NI Ple_5 State FL- Zip Code 3 Li 0 Business Telephone 37- 577- 1666 Contact Person M -A( 1 ;0.(4 Lobbyist/Contact E-mail MAR4-sy (v A 1&2 • CUf'') Notice for Lobbyists: The annual registration fee is S25.00 per Lobbjis(,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 AooK, 2. Name Address ` '/3-5— (" oe /2' Address City I flf e5 Zip Code 3`/J/O 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 Lobbyist Signature This registration wal sworn (or affirmed) and subscribed before me this 3%41 day of Al LC , 20 by k vc I = Personally Known BY: / Produced ID Deputy Clerk/Notary/Pub Type of ID Produced Revised:08/2014 Receipt# 007821893 8/4/2017 10:19:36 AM „Notcot„ Dwight E. Brock , Clerk of the Circuit Court LTi:Clf4v ��- cccpJ lye Customer Deputy Clerk Clerk Office Location MARTIN MANION BMR CASHIER Collier County Govt. Center NAPLES AREA BOARD OF MinutesandRecords@CollierClerk.co Building F, 4th Floor REALTORS (NABOR) m 3299 Tamiami Trail East, Suite 1455 PINE RIDGE RD 239-252-2646 401 NAPLES, FL 34109-2139 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# 028690 ($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. ©gal Page 1 of 1