2015/2016 Clerk to the Board, Minutes&Records Dept. Expires Qq
3299 Tamiami Trail East, Suite#401 (Staff use only
Building F,4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name JeKiC6,... Re 4.GL Date a 46
Business Address 1495 Smith Preserve Way
Naples FL 34102
Business Telephonep?s I—z2- of E-Mail C,44-..4eZo/7I
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 �4
day of HC 1 ,by 37Q.S LeG,Q , who is personally known to
me or has produced _ _ as identification and
who dii i 'N RGARET ANN—DAR—DIS
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:° `�• Notary Public-State of Florida
• " My Comm.Expires Nov 12,2017 BY: t.tp--� c a t-,-1 \ck
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T rou National Notary Assn.
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
� 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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