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2014/2015
Clerk to the Board,Minutes&Records Dept. Expires oq 745 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Ltd._ Date —Z l-6 Business Address !�-/ s° �� i 4-4 / ' t.1 e'(/ ' -es/ Business Telephone2g1 0 l E-Mail C 4-6,4 ± („oii-Cervv- i NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). 00/ e, '1'4hC-/f / WC- :44 ,ref_se IA) 1/11 s 0 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) Ldirb-Yist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this 214 day of ,by , who is personally known to me or has pr,1-- — — — — q —— — — — fp as identification and MARGARET ANN OAROIS who did takeRu,.,`"' syi Notary Public-State of Florida My Comm.Expires Nov 12,2017 zl Commission FF 4794 r Q O. ' ..JJ' ` Bonded Through t ough National Notary Men. BY: 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. RCVCIF.Jtft UV I J I UL I I 7/15/2015 11:11:35 AM ,t �,;" Dwight E. Brock A" ; �,'' Clerk of the Circuit Court .P\ 4k,Aor ____. ti -N \ ,__-7 -, _©ffffI J Customer Deputy Clerk Clerk Office Location JESSICA CRANE BMR CASHIER Collier County Govt. Center CONSERVANCY OF SW MinutesandRecords @CollierClerk.co Building F, 4th Floor FLORIDA m 3299 Tamiami Trail East, Suite 1495 SMITH PRESERVE WAY 239-252-2646 401 NAPLES , FL 34102 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# 14127 ($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. ©0[Ei0®Tg[l® gODEIO Page 1 of 1