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
NameQAft~~X E'SyrcEtJT Date NtJ'V {j::2D/(
Business Name L- () ~ G-- Bo W LD 1313 V
/
Business Address 50 0 G-t5>r<:-J>()/d fA (Cth4- D
City A) A-f' LE S State F L Zip Code 3 Lj I () g-
Business Telephone (9"-;0-- / J 8.:;Z Contact Person G-f] R rtJ:~7{-
Lobbyist E-mail G- F)( f?,E jrcE WI ~ If 0 L / CD till
Notice for Lobbvists: The annual registration fee is $25.00 per 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 Dwi2ht E. Brock, Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name No y F J3 I t0c 2. Name !VIAf~^J()L/1c pD;vY TKJzs;f(
Address 3J (5 fV\Abrvo (..../ A- .DR, Address f, fLf '7 ~A J+o(Z~e .A u e
City f\JA-P,--es:: Zip Code '3 f/ / ro City N fr f>LC'5 Zip Code 3)" 103
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3. Name LAW~eUCQlJ.j.TALBOT 4.Name NAf/L--e5 !.JAY; ve.- NI/!C..Seo/
Address 5'bb Gr 0 tl Qtvc-!t ~D Address '50 h bC) rcJ::>.. 0 /'J I It- ~
City (UA-ft..C's. Zip Code F L- City 'IV Ik Pee S Zip Code 34 I ~6
(A TT ACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
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State of Florida ..' I ,.';. . ~ ~r ~ :" /' '7,:'-"--'_,----"
County of Collier " :';:. . ?o. "'-:.'
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This r~~istration was sworn (or Jl,f.firmed) an. d subscribed before me this
f--l'O\J. , 2olL, by Mf . &~ vc? '^--t .
~ Personally Known' BY: fuw
Produced 10
Type of 10 Produced
Revised: 08/2011
Receipt# 007199127
11/1/20111:33:13 PM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
GARRETT BEYRENT
LONGBOW LOBBY
506 GORDONIA RD
NAPLES, FL 34108-2631
Deputv Clerk
BMR CASHIER
Minutesand Records@CollierClerk.co
m
239-252-2646
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
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE
Check# 1005
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.
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