2016/2017 Clerk to the Board, Minutes & Records Dept. Expires 7
3299 Tamiami Trail East, Suite #401 (Staff use only)
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
NameILkideew • Date I
l
Business Address ke TQflxn i
T3.\\Akba-) -a_ 3-05
� 1
Business Telephone 1�_t 1 a,) E-Mail \i�? '+ Wl��f-fd t o . l cJ
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). S.(2A
Yf)51 Cq55 •
L7ro Pan, FL 3 j7- JJD7
2). Air
aov) NW 04')
oigierk,
q
(PLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
jUsLia,
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscrib d before me on this o264--.6
day of �" ?'I by '( )PP.\,es�..iov, o is personally known to
me or has prod as identification and
ouinutttt1/4/
who did take an oath. ����o-vas;on
P \\e• '�e41PePuo4o `‹D
BY: �, �I� �� ' ✓ /i.'///F 81v1•6
•
Deputy Clerk/Notary Publi._ : of .
•
• �,°t'rzH cP.•
The annual registration fee is $25.00 per Lobbyist, accordingto Collier County '�, d'° rvoiss '•'
Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-2 "Iia° Wb73SdP�"��`'
and Ordinance 2013-39. �httti�m�N����
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.
Eimm
I1C1..CIIJL1f UV I 1 1.1L,PgJiJ
8/11/2016 3:05:36 PM
.,.. , Dwight E. Brock
Clerk of the Circuit Court
OFA.,.._. 0 tuld
71i}'C.IR< '
Customer Deputy Clerk Clerk Office Location
LAURALEE G. WESTINE BMR CASHIER Collier County Govt. Center
LAURALEE G. WESTINE, PA MinutesandRecords@CollierClerk.co Building F, 4th Floor
800 TARPON WOODS BLVD m 3299 Tamiami Trail East, Suite
STE 1 El 239-252-2646 401
PALM HARBOR, FL 34685- P.O. Box 413044
2011 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# 14328 ($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.
Cd0n@Q@gOlal Page 1 of 1
�I
Collier County Clerk of Courts Effective Date I Z1 17
3299 Tamiami Trail E. (Clerk's office only)
Suite 401,Bldg.F,4t1i Floor 6ece•1v - -Do 2p( !p
Naples,Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST WITHDRAWAL FORM f
NameLagjEt2 r�t - Date 12-46-1 '7"
Business Name The_ LO w afire,ff1( uP Ltim kie j '4Cs,.a111
Business Address g/y3 1ä( Yfl Lbjtj-401. atilt F
City r ` State �rr
` 1..� Zip Code 21405
Business Telephone l !—113 p2J Contact Person k a_ht
1 ,
Lobbyist E-mail rt " ' `. ►a 11 i . • _
i, �Cl Qle� 1 ,having registered in Collier County,on
as a lobbyist,hereby submit a request for withdrawal. I understand that pursuant to Section
112.3148,of Florida Statutes,that my name shall continue to appear on the list of lobbyists
until the expiration of the time period set forth in said statute. My last activity as a lobbyist
was on /lotb ,20 )7 .
State of Florida
County of Collier
Lobbyist Signature
This re istration was sworn(or affirmed)and subscribed before me this day of,
,20 ;by 0Y20.24..)l�/ lCJlr ::�.,�:�,,,,,,,,
0018,.gmber-/7iy.•
,Z
dtl' ,
V Personally Known AL t f".r 4 ,, r.
/
Produced ID Deputy Cl. 'r48iibli 'i`
Type of ID Produced %,' ' uristPoW
sTitiOf
4///111111100
Revised:08/2011