Paid Lobbyist Registration — Dirk Kuczurba, Palm Beach County Registration (2011)

PALM BEACH COUNTY FLORIDA RECEIVED NOV 16 2011 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, FL 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: Dirk Kuczurba Firm Name: S&K Realty Group, LLC Address: 150 Alhambra Circle, Suite 800, Coral Gables, Florida 33134 Legislative Interest of Principal: Land Development 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 Principal Signature Lobbyist Retained Date X Registrant/Lobbyist Signature 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

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 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 THIS DOCUMENT CONTAINS HEAT SENSITIVE INK - TOUCH OR PRESS HERE - RED IMAGE DISAPPEARS WITH HEAT || 27179 First Bank of The Palm Beaches West Palm Beach, FL Check Date Nov 09, 2011 Amount $25.00 27179 Authorized Signature Security Features Included. Details on back. MP SECURE SAFEGUARD