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2014/2015
Collier County Clerk of Courts Expires `-�/ 1 ✓ 3299 Tamiami Trail E. (Clerk s office only) Suite 401, Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS, LOBBYIST REGISTRATION FORM Name D 7)/4' 112 e-- Date Z Business Name a2 l - )It,V 4 � Business Address L/'P i1 ,ez,2 City " State / ' Zip Code 3 e-7/7/1 Business Telephone "35-3 -9/0- Contact Person 1 47,62-0-211.- )C 1414-/e-- Lobbyist E-mail 4 `0`1-617 ✓`-0-542 6'4 ) i 09iv Notice for Lobbyists: The annual registration fee is$25.00 per Lobbyist, 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 Dwight E. Brock, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name (N '° 1/-7. - 2. Name Address 0ti .25° Address City Zip Code City Zip Code 3. Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier Lobbyist Signature T l is registration was sworn(or affirmed and subscribed before me this _C ^� day cif, •�:I , 20 lS , by � I'r Personally Known BY: i ®® /� Produced ID Deputy Clerk/Notary 'ubf Type of ID Produced evise•:'08/2011 IUC..CItJLff VV I JJ I I JV 4/24/2015 12:13:13 PM C,K<<„AT Dwight E. Brock ` Clerk of the Circuit Court a . C1 CJ _� .._ ©' tcI 1 ,RlClti< �� _ _�\c\ �.7 V V Customer Deputy Clerk Clerk Office Location ROBERT DUANE BMR CASHIER Collier County Govt. Center ROBERT L. DUANE & MinutesandRecords @CollierClerk.co Building F, 4th Floor ASSOCIATES m 3299 Tamiami Trail East, Suite 4880 TAMARIND RIDGE DR 239-252-2646 401 NAPLES, FL 34119-2826 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# 1401 ($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. ©®011 ° P©D® gQa11 Page 1 of 1