1998/1999
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County of Collier
CLERK OF THE CIRCUIT COURT ~
COLLIER COUNTY COURTHOUSE ~\q
3301 TAMIAMI TRAIL EAST
P.O. BOX 413044
NAPLES, FLORIDA 33941-3044
Dwight E. Brock
Clerk
OFFICIAL RECEIPT
When Validated
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BRANCH OFFICES:
GOLDEN GATE
4839 GOLDEN GATE PARKWAY
GREENTREE SHOPPING CENTER
2386 IMMOKALEE ROAD
IMMOKALEE
101 S. FIRST STREET
MARCO ISLAND
1040 WINTER BERRY DRIVE
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COLLIER COUNTY
3~01 Tamiami Trail East
Naples, Florida 34112
C?89DOO
NAME [JJjJ /4L f)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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BUSINESS ADDRESS Sf SO 11, T7twt J /41J1 (
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NAMES AND BUSINESS ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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DATE 5/2 7 /'79
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ATTACH ADDITIONAL SHEETS AS MAY BE NECESSARY
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Y st SJ.gnature
STATE OF FLORIDA
COUNTY OF COLLIER
The foregoing registration was sworn to and su
this the :2, i:L da
who is personall nown to m
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ta~e an: oath,
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Deputy ClerkINptary,P1ibl~c
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Please Note. 1) Failure to renew this registration by th9nr~newal
date of October 1Bt will result in the placement of this rl~fstraht on
a "status unknown" list. 2) If one wishes to revoke thi~~. .
registration, a "Lobbyist Withdrawal" form must be filed with the
Clerk to the Board. 3) Annual Registration Fee is $25.00 per
Lobbyist according to Ordinance 99-22
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BY: