2015/2016 0 Clerk to the Board, Minutes&Records Dept. Expires
3299 Tamiami Trail East, Suite#401 (Staff use only)
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name in ie r e d i iiit ea t^VI G / ,d Date ^''��'1w
Business Address 1495 Smith Preserve Way
Naples FL 34102
Business Telephone d‘N/02 03 a`/ 3662 E-Mail /n C f ee i.l4[, O lot.l Pi l/Ghcy,61
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). Conservancy of Southwest Florida
1495 Smith Preserve Way
Naples FL 34102
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY)
*/..(4d,(4.a.A,--ata
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this ).4
day of 90,,,0 ,by /y Ems,dt tL 4c,_,,,,,d ,who is personall ky nown to
me or has produced as identification and
who did take an oath.
a4• ,P,.,,� MARGARET ANN DARDIS r
3i° _ ..St Notary Pub ie-State of Florida BY: tic-Iv-LA Cl r ��{�
.4 My Comm.Expires Nov 12,2017
ass, Commission#FF 48794 Deputy Clerk/Notary Public
''jI�°i��`�� Bonded Through National Netary Asan.
Te-airnnarregIsTramm 1'ee'w$ 5. 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.
I\GI.GIFJI r VVI V/V I $J
5/5/2016 2:53:55 PM
,i :kc,„ :r Dwight E. Brock
((//-% - �t ` Clerk of the Circuit Court
i /
ce.
y
I-• E ----, ----- — —1,---, fl,
Customer Deputy Clerk Clerk Office Location
MEREDITH BARNARD BMR CASHIER Collier County Govt. Center
CONSERVANCY OF SW MinutesandRecords@CollierClerk.co Building F, 4th Floor
FLORIDA m 3299 Tamiami Trail East, Suite
1495 SMITH PRESERVE WAY 239-252-2646 401
NAPLES , FL 34102 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# 15888 ($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.
I DOUIRIg[ Vig gOD Page 1 of 1