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2011/2012 Collier County hClerk of Courts Expires ires "v '� 3299 Tamiami Trail E. (Clerk' office only) Suite 401, Bldg. F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Theodore R. Walters Date Business Name Cummings & Lockwood LLC Business Address 3001 Tamiami Trail North, Suite 400 City Naples State Florida Zip Code 34103 Business Telephone 239 .2 6 2 . 8 311 Contact Person Lobbyist E-mail twalters @cl-law. corn Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name A&D Real Estate Holdings II 2. Name Donald Smith Address 9848 Brassie Bend Address 9848 Brassie Bend City Naples Zip Code 34108 City Naples Zip Code 34108 3. Name Ken Knief 4. Name Address 2380 Vanderbilt Beach Road Address City Naples Zip Code 34109 City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State y Florida �A.o 9 0 County of Collier Lobbyist Signature +h This registration was sworn(or affirmed)and subscribed before me this ! 1 day of, April , 20 ,by Theodore R. Walters X Personally Known BY: - '` CL9 C',_- Produced ID ( Deputy Clerk/Notary Public Type of ID Produced , ,,,n: JEAN A.CEA i.,T MY COMMISSION#DD 949913 Revised:08/2011 T' 2 EXPIRES:January 23,2014 .�igs f ,,�of 1hcE;•� Bonded Thru Notary Public Underwriters Receipt# 007241204 4/23/2012 9:18:27 AM Dwight E. Brock Clerk of the Circuit Court �T!'tk CIR`t` o Customer Deputy Clerk Clerk Office Location THEODORE WALTERS BMR CASHIER Collier County Govt. Center CUMMINGS & LOCKWOOD MinutesandRecords @CollierClerk.co Building F, 4th Floor LLC m 3299 Tamiami Trail East, Suite 3001 TAMIAMI TRL N STE 400 239-252-2646 401 NAPLES, FL 34103-2744 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# 34092 ($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. ©0000®TgOQg'0Ela Page 1 of 1