2011/2012
Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
EXPires~~
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
'D 6 LA 31 & s L - f( ct Y) k, \ V\ Date 1 ().. / 7-1 J
BusinessName U1IA.J Ot'~l~e O~D6L(3)&.S; L, Kank('v\"
Business Address d S 3 S- 'lD..~. 10.. YY\ I Tr U I ) AI 'H .30 ~
F L Zip Code 3L1 /t13
Name
City Napjes
Business Telephone J 3/1- d~ J -1J()fn I Contact Person m e
Lobbyist E-mail dfDnJ(f.Y1@S?(J.VllfYla J' J ,(' /j(Yl
State
Notice for Lobbvists: The annual registration fee is $25.00 oer Lobbvist, per Collier County
Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24.
Payments made out to: Collier County Clerk of Courts or Dwie:ht E. Brock. Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
04/Yl G C~/2.~~f3; ~
~ddress NO
Address
1. Name
City
Zip Code
City
Zip Code
3. Name
4. Name
Address
Address
City Zip Code
(AlTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
City
Zip Code
......................................................................-..-..-............-..-...................................-...................................................-..-....................................................-.......-......................-..............................................................................................................-...........-..-..-..-
State of Florida
County of Collier
...._~;>',<s.(
Lobbyist Signature l':,,~:.-:-:::-:.i:". :',,:- :
'-", ('.... r:'I>.' /~
~ <'<.I' .. c(""'\ ',,,,, . ." '. ,~ -...
"'~......... . ~\ \ ~t..,., ~ ,,:;j''' ~
1\ ~~!<;gistration was sw<>P1-Cor ~edJ and subscribed before me this J~ ~~~i;':: ~.. ~
U~ , 2olL, by ----12. ~t1r\- . ~ ~.. :>,,~ . ~. , .': ::'
/' ~ ~ .. . .,~.r '.,,' ~:)' .~
~ Personally Known BY:~' ~>....~,~J.~;~t';~",-:'
Produced ID
Type ofID Produced
Revised: 08/2011
Receipt# 007195576
10/17/2011 3:05:55 PM
Dwight E. Brock
Clerk of the Circuit Court
(r))tllf'ncsoaniJ ~C~x(~;GijnG(DG
Customer DeDutv Clerk
DOUGLAS L. RANKIN BMR CASHIER
LAW OFFICE OF DOUGLAS L. MinutesandRecords@CollierClerk.co
RANKIN m
2335 TAMIAMI TRL N STE 308 239-252-2646
NAPLES, FL 34103-4458
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3299 Tamiami Trail East, Suite
401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION
1 BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE
Check# 22014
BALANCE DUE
AMOUNT
$25.00
$25.00
($25.00)
$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.
@@DD~@a@D@afuo@@lliID
Page 1 of 1