2009/2010
Receipt# 007036721
12/1/20099:43:09 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
DONALD PICKWORTH
DONALD PICKWORTH
5150 TAMIAMI TRL N STE
502
NAPLES, FL 34103-2822
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Gov\. Center
Building F, 4th Floor
3301 Tamiami Trail East
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Cash Tendered:
Cash Returned:
BALANCE DUE:
AMOUNT
$25.00
$25.00'
($50.00)
$25.00
$0.00
Page 1 of 1
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Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRA nON FORM
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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pLEASE ATIACH ADDITIONAL SHEETS IF NECESSAR~
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Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this / :M.-
day 0~1..<<". 2101-, by , who is personally known to
me or has produced -FL 'Dt-- as identification and
who did take an oath.
Deputy ClerkINotary Pub c
The ann ual registration fee is $25.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
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