2015/2016 Clerk to the Board, Minutes &Records Dept. Expires061
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3299 Tamiami Trail East, Suite#401 (Staff use only
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name
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Business Address 1495 Smith Preserve Way
Naples FL 34102
Business Telephone ACt—e774'0?-°SOY E-Mail gel%i't ih ...Cev dei''(, 4/76ift
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). Conservancy of Southwest Florida
1495 Smith Preserve Way
Naples FL 34102
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY)
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Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this
day of ly ca�y 1 r; ,by IR , who is personally known to
me or has produced as identification and
who didl �e�„atppa . MARGARET ANN DARDIS
iti r Notary Public-State of Florida
My Comm.Expires Nov 12,2017 t�
Ali Commission+y FF X8794 BY: it ICI Cid-- Q N ek
%RAn;• Bonded Through Wiener Notary Man.
— ——— — — — — —— — — 4 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.
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6/13/2016 3:35:06 PM
Dwight E. Brock
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Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
REGAN FINK, SEAN MCCABE BMR CASHIER Collier County Govt. Center
& JESSICA REHA MinutesandRecords@CollierClerk.co Building F, 4th Floor
CONSERVANCY OF SW m 3299 Tamiami Trail East, Suite
FLORIDA 239-252-2646 401
1495 SMITH PRESERVE WAY P.O. Box 413044
NAPLES , FL 34102 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
3 BMR Lobbyist Registration $25.00 $75.00
TOTAL AMOUNT DUE $75.00
Check# 16170 ($75.00)
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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