2017/2018 4SClerk to the Board, Minutes & Records Dept. Expires ®! (
3299 Tamiami Trail East, Suite #401 (Staff use onl )
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Laura DeJohn Date 08/01/17
Business Address 2350 Stanford Court
Naples, FL 34112
(239) 334-0046 Idejohn@johnsoneng.com
Business Telephone E-mail
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). Habitat for Humanity of Collier County
11145 Tamiami Trail E
Naples, FL 34113
2).
(PLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
4.4
Lobbyist Signature
State of Florida
County of Collier
The fore oing registration was sworn to and subscribed before me on this
.t S--
day of 1 U«, by t .A �E 5 i-� ) , who is perste known to
me_ or has produced as identification and
who did take aohy
/0"44% AMANDA MAE MARTIN ,�n
Notary Public•State of Florida BY: �� G o I i //l nOA
'My Comm.Expires Jun 19.2018 .� ,Yom)
( 4a�N '�� Commission N FF 95921
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.
Receipt# 007821888
8/4/2017 10:14:59 AM
c000KcoN Dwight E. Brock
Clerk of the Circuit Court
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ffir C _ a' _ cc Ce7 _ EDQ
Customer Deputy Clerk Clerk Office Location
LAURA DEJOHN BMR CASHIER Collier County Govt. Center
JOHNSON ENGINEERING MinutesandRecords@CollierClerk.co Building F, 4th Floor
2350 STANFORD CT m 3299 Tamiami Trail East, Suite
NAPLES, FL 34112-4813 239-252-2646 401
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# 33420 ($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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