2003/2004County of Collier
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY COURTHOUSE
3301 TAMIAMI TRAIL EAST
P.O. BOX 413044
NAPLES, FLORIDA 34101-3044
ORIGINAL
OFFICIAL RECEIPT
When Validated
BY: ANN J
DEPUTY CLERK
RECEIPT: 4064511
NAME : MICHAEL A. MYERS
PAYOR: MICHAEL A. MYERS
REFNC: APJ
DEPT: BOARD MINUTES AND RECORDS
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TOTAL DUE: 25.00
Page 01 of 01
COLLIER COUNTY
3301 Tamiami Trail East
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
NAME
BUSINESS ADDRESS
DATE Q
NAMES AND BUSINESS ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1)
2)
ATTACH ADDITIONAL SHEETS AS MAY BE NECESSARY
Lo
Lobby Signature
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing registratios�kra�s pwor andbsubscribed before me on
this the of 1/U`'nyyt( y
who it ersonally kno to me or who has produced
as identificat on and who did take an oath.
MyCWM*WMDDm1e1e BY:
" E'PWU M80n•20M Deputy Clerk/Notary Public
Please Notat 1) Failure to renew this registration by the renewal
date of October Vt will result in the Placement of this registrant on
a ■status unknown" list. 2) If one wishes to revoke this
registration, a "Lobbyist Withdrawal■ form must be filed with the
Clerk to the Board. 3) Annual $egistration Fee is $25.00 per
Lobbyist according to Ordinance 99-22