2011/2012
Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
EXPires~
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name C3-.HJ2./7 /IA-~4N Date e!z,&/; I
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Business Name 1/4a AN ENCi I J./G'f:1ZIAlr;. " L. t C
Business Address Zz.6G cpUeEN;:5 t()A Y
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City tJA-P6cS
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Zip Code
34/6Z
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State
Business Telephone Z 30) - t;5/ h '€t Z-3Q Contact Person
Lobbyist E-mail C h r- /s t2. ;/ d..j q Y/ C 11", ~ m
Notice for Lobbvists: The annual registration fee is $25.00 ner Lobbvist, 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 Dwi2ht E. Brock. Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENTIENTITY REPRESENTED:
1. Name
-r13p
2. Name
Address
Address
City
Zip Code
City
Zip Code
3. Name
4. Name
Address
Address
City Zip Code
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
City
Zip Code
State of Florida
County of Collier
Revised: 08/2011
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Receipt# 007183418
8/26/2011 12:45:32 PM
Dwight E. Srock
Clerk of the Circuit Court
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Customer
CHRIS HAGAN
HAGAN ENGINEERING, LLC
2286 QUEENS WAY
NAPLES, FL 34112-5424
Deputy Clerk
BMR CASHIER
MinutesandRecords@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
FEE QTY
1
DESCRIPTION
BMR Lobbyist Registration
FEE NAME
BMR Lobbyist registration Fee
UNIT COST
$25.00
AMT TOTAL
$25.00 $25.00
TOTAL AMOUNT DUE:
Check# 1015
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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