Paid Lobbyist Registration — Shawn Wilson, Palm Beach County Registration (2010)

PALM BEACH COUNTY FLORIDA RECEIVED NOV 22 2010 PALM BEACH COUNTY Board of County Commissioners Paid Lobbyist Registration Form Fill out information requested and return original completed form to the address below. It is the duty of each lobbyist to continually update and file this information. Application does not expire until a Paid Lobbyist Withdraw Form is submitted. A Fee of $25.00 is due upon registration of each principal, payable by cash or check. Name of Lobbyist: Clifford Hertz Business Phone: (561) 832-3300 Firm Name (if applicable) Broad and Cassel Business Address (Street/P.O. Box, City, Zip Code) 1 North Clematis Street Suite 500, West Palm Beach, Florida 33401 Description of nature and extent of any direct business association or partnership with any current Palm Beach County Commissioner, Advisory Board member or County employee: Wife - Paula Ryan - Planning Commission; Commission on Affordable Housing Principal Represented Principal Name: Shawn Wilson Firm Name: Housing Trust Group, LLC Address: 750 Malibu Bay Drive, West Palm Beach, FL 33401 Legislative Interest of Principal: Land Use and Zoning In compliance with Palm Beach County Lobbyist Registration Ordinance, Palm Beach County Code, Chapter 2, Article VIII, as amended, I hereby submit this registration form, and state that the information contained herein is true and correct. Registrant/Lobbyist is authorized to represent the above principal x Shawn Wilson Principal Signature 10/5/10 Lobbyist Retained Date x [Signature] Registrant/Lobbyist Signature 10/15/10 Date Return original completed form to: Todd Bonlarron, Legislative Affairs Director 301 N. Olive Avenue, Suite 1101 West Palm Beach, FL 33401 (561) 355-3451

BROAD AND CASSEL VENDOR: 34697 Palm Beach County Board of County Commissioners Acct. # Check No.: 23543 REF # INV. # INV. DATE INV. AMOUNT INV. DESCRIPTION AMT. PAID 448990 20101119. 11-19-10 25.00 29466.0068 - Lobbyist 25.00 LITHO USA 5F8L7L 06799147L

BROAD AND CASSEL VENDOR: 34697 Palm Beach County Board of County Commissioners Acct. # Check No.: 23543 REF # INV. # INV. DATE INV. AMOUNT INV. DESCRIPTION AMT. PAID 448990 20101119. 11-19-10 25.00 29466.0068 - Lobbyist 25.00 ORIGINAL DOCUMENT PRINTED ON CHEMICAL REACTIVE PAPER WITH MICROPRINTED BORDER BROAD AND CASSEL OPERATING ACCOUNT 1 NORTH CLEMATIS STREET, SUITE 500 WEST PALM BEACH, FL 33401 First Bank of The Palm Beaches West Palm Beach, FL 23543 Check Date Nov 19, 2010 Amount $25.00 Pay: TWENTY-FIVE AND 00/100 TO THE ORDER OF Palm Beach County Board of County Commissioners 301 N. Olive Avenue West Palm Beach, FL 33401 Authorized Signature SAFEGUARD SECURES SAFEGUARD SECURES THIS DOCUMENT CONTAINS HEAT SENSITIVE INK. TOUCH OR PRESS HERE - RED IMAGE DISAPPEARS WITH HEAT. 23543