2013/2014 •
Clerk to the Board, Minutes& Records Dept. Expires aol�.
3299 Tamiami Trail East, Suite#401 (Staff use only
Building F,4th Floor
Naples,FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name / sy` 6 Date
Business Address 7 0 B6"-).--'//2- ARC.-41 //i,-r-
Business Telephone 'YG 7- 765 -Q To- E-Mail 7-4 (12,1 C 1.,,F}.-vdtksu/mod/0"J- tit,
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). Ol G `'i,U Iev-✓ 412 14-/V1,-) L L
7 3 D )3 a ,,' /s/q ' -,
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECES<ARYT
Lobbyist Si ature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this
Q+4,
day of March,2014 , by--' he oc s L. eaugn2tek, who is personally known to
me or has produced as identification and
who die
ter
f 40 Notary Public State of Florida
Donna t But
p� b1y Commission EE148854 BY: -+ `u% . rd""
'?a oaF Expires 12!2812015
Deputy Clerk/Notary Public
The annual registration fee is$25.00 per Lobbyist, according to Collier County
Ordinance No.2003-53,as amended by Ordinance 2004-05,Ordinance 2007-24
and Ordinance 2013-39.
Please make payment to: Collier County Clerk of Courts or
Dwight E. Brock,Clerk of Courts and mail to the address listed at the top of the form.
Receipt# 007435132
4/3/2014 8:25:49 AM
Dwight E. Brock
.:.\ Clerk of the Circuit Court
) o o
cy ffff@I
Customer Deputy Clerk Clerk Office Location
TOM CAVANAUGH BMR CASHIER Collier County Govt. Center
ORCHID RUN APARTMENTS, MinutesandRecords @CollierClerk.co Building F, 4th Floor
LLC m 3299 Tamiami Trail East, Suite
730 BONNIE BRAE ST 239-252-2646 401
WINTER PARK, FL 32789- P.O. Box 413044
2809 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
1 BMR Lobbyist Registration $25.00 $25.00
TOTAL AMOUNT DUE $25.00
Check# 1011 ($25.00)
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.
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