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2015/2016
Now Clerk to the Board, Minutes&Records Dept. Expires 0" tU1 V 3299 Tamiami Trail East, Suite#401 (Staff use only Building F,4th Floor Naples,FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM NamegeV �i1 K Date '1 fel.1495 Smith Preserve Way Business Address Naples FL 34102 Business Telephone 34 a2o'2-Cys Off( E-Mail C ' '9 Pte.Co/7.1e7 V4fC�s 0 ey 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) Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this 7 day of Tuv42_, f 6 ,by Asz 7 a n �ArjG ,who is perso own to me or has produced as identification and who did take an oath. • ( MARGARET ANN DARDIS 11"-,k144:,% 'lam C �. No: Public State of Florida BY. Flo, c 3 My Comm.Expires Nov 12,2017 1 b Commission#FF 48794 Public 44% � ?' Bonded 9 Assn. ' Deputy Clerk/Notary '44%%%%%%% Throu it National Notary The annua reg>tstrat>lon fee is $ 5.00 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. mc.cipuf VVI WU VU 6/13/2016 3:35:06 PM } Dwight E. Brock �, Clerk of the Circuit Court '` „JAI o o - @©i- 0 ICDER 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. ©DUMIT©ll® galtiO Page 1 of 1