2012/2013 Collier County Clerk of Courts Expires �/3
3299 Tamiami Trail E. (Cler 's office only)
Suite 401, Bldg. F,4th Floor
Naples,Florida 34112
I
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Allen J. Mank, P.E. Date 10/24/12
Business Name Weston & Sampson, Inc .
Business Address 4210 Metro Parkway
City Fort Myers State Florida Zip Code 33916
Business Telephone (239) 437-4601 Contact Person Allen J. Mank
Lobbyist E-mail manka@wseinc . com
Notice for Lobbyists:, The annual registration fee is 525.00 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 See Attached List 2. Name
Address Address
City Zip Code 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 ,' - j< < ,'c—E''"
Lobbyist Signature
This registration was sworn (or affirmed) and subscribed before me this 24 day of,
October , 20 12 , by Allen J. Mank
X Personally Known BY: c./ lA%/ /
_ _..._
Produced ID P eputy • el-lc/Notary Public
Type of ID Produced -
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` �s MYRIAM JENNY LONDONO
i ,r % Notary Public-State of Florida Revised:08/2011
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•.,,;;;;;; •s Commission#EE 842810
12730 New Brittany Boulevard,Suite 600
Fort Myers,FL 33907
tel: 239-437-4601 fax: 239-437-4636
www.westonandsampson.com
Westoedampsoile
TRANSMITTAL
MEMORANDUM
To: Collier County From: Jenny Londono
Clerk of Courts Administrative Assistant
3301 Tamiami Trail East londonoj @wseinc.com
Naples, FL 34112
Date: October 24, 2012 Cc: File
Re: Lobbyist Registration Renewal
We are sending you via US Mail the following:
Copies Date Description
1 Check for$75.00
1 Lobbyist Registration forms for each employee listed below
1 Client List
Employees:
Jeffrey A Wilson
Robert M. Mitchell
Allen J. Mank
G:ILibra,y Lobbyist InfolCollier12012iCollier_101112.doc
Massachusetts Connecticut Rhode New Maine Vermont New York New Jersey Pennsylvania South Florida
Island Hampshire Carolina
Peabody(HQ) Rocky Hill Coventry Portsmouth York Waterbury Poughkeepsie Cinnaminson Pottstown Charleston Fort Myers
Foxborough Rensselaer Edison
Woburn
Bourne
Chatham
South Yarmouth
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Receipt# 007288710
10/26/2012 8:56:02 AM
� ,; Dwight E. Brock
'`' Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
JEFFREY A. WILSON, BMR CASHIER Collier County Govt. Center
ROBERT M. MITCHELL & MinutesandRecords @CollierClerk.co Building F, 4th Floor
ALLEN J. MANK m 3299 Tamiami Trail East, Suite
WESTON & SAMPSON, INC. 239-252-2646 401
4210 METRO PKWY P.O. Box 413044
FORT MYERS, FL 33916-9487 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
3 BMR Lobbyist Registration $25.00 $75.00
TOTAL AMOUNT DUE $75.00
Check#96811 ($75.00)
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.
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