2014/2015 Clerk to the Board, Minutes& Records Dept. Expires LS
3299 Tamiami Trail East, Suite #401 (Staff use only
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name kW.A.1 )o J�L�� Date
Business Address I•)-I if-/ i [Coe
Business Telephone'-(O 3(67 7(' ' E-Mail 4Sbll(Gd SDtit .(4h Li)/vi
NAME Ep AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). V eArtZIJY• 14)01-IC SS
I - OS-5- RAUVrA t9 rive„ tt t (OO
lLMA jai.., PL 33(o3 7
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY)
Lobbyist Signature
State of Florida
County of Collier 'rt"-'SsA--
The fore ping registration was sworn to and subscribed before me on •
day of j ( 020/5- , by illA r Y SO f;, . , who ' .ersonal ly known to
me or has produced 1 as i.e • • • and
who did take an oath.
t :!":,4'c KAREN P.HARTNER KAREN P.HARTNER
*stag MY COMMISSION><FF OB�888 Ni
:OMMISSION t FF 084888 B Y: /, . /a EXPIRES:January 24,2018: ''S:January 24,2018
eaaaeoTMusuagetNotarySenK� -,lxtNawysavkea 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.
/\G\.0 I t. 111' UV I J V I I I J
7/21/2015 2:48:35 PM
17,AKY:;.?,,i,, Dwight E. Brock
r u.q1 Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
MARY DOTY SOLIK BMR CASHIER Collier County Govt. Center
DOTY SOLIK LAW, P.A. MinutesandRecords @CollierClerk.co Building F, 4th Floor
121 S ORANGE AVE STE m 3299 Tamiami Trail East, Suite
1500 239-252-2646 401
ORLANDO, FL 32801-3241 P.O. Box 413044
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# 1345 ($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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