2017/2018 Collier County Clerk of Courts Expires (-)6?
3299 Tamiami Trail E. (Clerk's et Only)
Suite 401, Bldg. F, 4th Floor
Naples,Florida 34112
COLLIER COUNTY LOBBYIST REGISTRATION FORM
Lobbyist Name fr)e Date , U I ) Z 0/ 7
Business Name ihlr)er f C S Arrr
Business Address q6 I Cc P1/1.iCt I 77 A!
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City Ng-fie-3 State Zip Code 3 Li c
Business Telephone 3 ' sqaContact Person c9C,C. Hr_h 65-
Lobbyist/Contact E-mail 0e • oit r '( 31
111,
Notice for Lobkvists: The annual registration fee is$25.O0 per Lobbyist,per Collier County Ordinance No.
2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39.
Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts(ADDRESS ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1.Name f P 2.Name
Address 414677apit(e
' - r- N 4201,o Address
City 41e---C Zip Code
51-ile_ity Zip Code
3,Name 4.Name
Address Address
City Zip Code City i. çode
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of Florida
County of Collier
Lobbyist • 41.1010101."-" :01
This registration was swo or affirmed) and subscribed before me this I / day of,( ,
lj
20 1. , by
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1171
13;ersonally Known BY: alkr
1-- Produced ID Deputy Clerls/Notary, ublic
Type of ID Produced
Revised:08/2014
Receipt# 007813765
7/11/2017 8:37:16 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
LOUIS PICHE BMR CASHIER Collier County Govt. Center
AMERICANS FOR MinutesandRecords@CollierClerk.co Building F, 4th Floor
PROSPERITY m 3299 Tamiami Trail East, Suite
4949 TAMIAMI TRL N STE 206 239-252-2646 401
NAPLES, FL 34103-3017 P.O. Box 413044
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#2018 ($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.
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