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2011/2012 Clerk to the Board,Minutes&Records Dept. Expires 0(7 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples,FL 34112 BOARD OF COUNTY COMNIISSIONERS LOBBYIST REGISTRATION FORM I,.249r2 Name Richard L. Wu Date Oct. , 011 Business Address 2910 Kerry Forest Pkwy,D4-164 Tallahassee,FL 32309 Business Telephone 850-894-3887 E-Mail rlwuac304@earthlink.net NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Robert Beattie 9140 CARRIBEAN BOULEVARD MIAMI,FL 33157 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) Lobbyist Signature State of Florida County of Collier sT The foregoing registration was sworn to and subscribed before me on this — day of OCTO( '(L ,by (Lt C+tArp �. v..10 ,who i .nally kno .• me or has produced ` ,3�.QN R!')4F���i,,4/ -T a I , 11 on and who did take an oath. 05� ••"�H•AOIq''� moo Cx - t-. CD 744177 :o i • Q� %'':'��80,oaa ,-'�• o` Deputy Clerk/Notary Public , Awl....... rc• The annual registration fee is$25. •• t,according to Collier County Ordinance No.2003-53,as amended by Ordinance 2004-05 and Ordinance 2007-24. Please make payment and mail to: Collier County Clerk of Courts or Dwight E.Brock, Clerk of Courts(at the address listed at the top of the form). Receipt#007221740 2/9/2012 9:48:06 AM Dwight E. Brock Clerk of the Circuit Court -\ o � � C - - RecIL Customer Deputy Clerk Clerk Office Location RICHARD L. WU BMR CASHIER Collier County Govt. Center 2910 KERRY FOREST MinutesandRecords @CollierClerk.co Building F, 4th Floor PARKWAY, D4-164 m 3299 Tamiami Trail East, Suite TALLAHASSEE, FL 32309 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 Cash Tendered ($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. ©Qo Q011®T© ( gQlE6) Page 1 of 1