2009/2010
Receipt# 007022930
9/29/20092:49:16 PM
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Dwight E. Brock
Clerk of the Circuit Court
Customer
BRAD CORNELL
556 109TH AVE N
NAPLES, FL 34108-1808
Deputy Clerk
BMR CASHIER
Minutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3301 Tamiami Trail East
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION
1 BMR Lobbyist Registration
UNIT COST
$25.00
TOT AL AMOUNT DUE:
Check# 1809
BALANCE DUE:
AMOUNT
$25.0(
$25.00
($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
Expires C{ \'1-0 I 0
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Date Cf /2 q I 0 Cf.
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Name i)n~ Lu(tIle-t t
Business Address I 0-10
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Business Telephone (; L{ 3 - 7 i ~ L
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
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Lobbyist Signat · e
State of Florida
County of Collier
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BY: 0>>-0 ~~:H'.
Deputy Cler . . . ary ublic
The annual registration fee is $25.00 per Lobbyist, according to CoUler 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).