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2012/2013 Collier County Clerk of Courts Expires 9/ 20/3 3299 Tamiami Trail E. (Clerk s office only) Suite 401,Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Jeffrey A. Wilson, 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 Jeffrey A. Wilson Lobbyist E-mail wi1son.j@wseinc . com 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 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 „ A Lob i i i This registration was sworn (or affirmed) and subscri bef. - me this 2 4th day of, October , 20 12 , by Jeffrey A. Wilson X Personally Known BY: U/. i� Produced ID _ _ _ of u rk/Notary ublic Type of ID Produced MYRIAM JENNY LONDON Notary Public-State of Florida } My Comm.Expires Oct 11.2016 Revised:08/2011 '°s,oa .• Commission s 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 cn < c-I0i v 73 N c < cn-8 oola 0 3 w M ID 0 CD 0 (T)* c° CD a 0 fD W IIo z ' < O N 01�I fD U) 3i on T v o r ' climcDO ° CO co fl) o cn _ cn > n "C o l oV co m 0 `! z 5. cn CD _- rn o • N N N.) col co W W � OoCOOD C)i al O co Y.' c° O O c_ N a N X ,N N 2 = = — m cn 3 m m N ° v � c° v •a) p0 O r . 3 � O m �` ao C OZ- O O CD O • a Q CD m Iw a; co — O (D CO CI V c o D ^) a a Z zzz5 zlzcn fl) CU fl) fl) 0. fl) N CA • N � 0) cn N CU 0 -o r -nT „ 51-n -n1 w n) v v fy v fla) v w w'w t� OD Ca w N o- 0 0 0 0 W c° c° co .. c° o Receipt# 007288710 10/26/2012 8:56:02 AM � ,; Dwight E. Brock '`' Clerk of the Circuit Court nz C \� (�I (s� J 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. C 000n®PQQ ❑gOEID Page 1 of 1