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2013/2014
Collier County Clerk of Courts Expires q iiZti i .( 3299 Tamiami Trail E. (Clerk's office only) Suite 401, Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Tat'y S Earl V---S Date Business Name � L I- rrUe0 V 0 1 `Ct' y- ✓1 tce , J.1,1-- .1 `G . Business Address 1 CO i 2l St' St— lit) `J City r V:S• State F-1---- Zip Code 34(20 Business Telephone Lam"/' (1'r21(0-7 Contact Person Lobbyist E-mail VitY1b5UC.3i CO 4/511 .c D(14_ Notice for Lobbyists: The annual registration fee is$25.00 per Lobbyist, 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 Dwight E. Brock,Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name C� u viajl(S/ 1��°j e Address 10Ce gj 1Jin, Ve-- Address City Ott 4 16 Zip Code34-1 0 0 City Zip Code 3. Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida / ,, ,,;�,, ;:;,;.,,.County of Collier , '` .` �; Lo,by' ilnature °••°°° re istration was swo affirmed d subscribed before me this - J :-; oa ofi 0 . `, V g -Y T T�?Is ,20 ,by VLL S e) c� ' `- cIw( � � G u I—Personally Known BY: Produced ID Depu,, Cl- !!h otatyPublfc Type of ID Produced Revised:08/2011 Receipt# 007384152 10/8/2013 9:34:01 AM ,F<<,; Dwight E. Brock Clerk of the Circuit Court 0 \tR Customer Deputy Clerk Clerk Office Location JAMES M BANKS BMR CASHIER Collier County Govt. Center JMB TRANSPORTATION MinutesandRecords @CollierClerk.co Building F, 4th Floor ENGINEERING INC. m 3299 Tamiami Trail East, Suite 761 21ST ST NW 239-252-2646 401 NAPLES, FL 34120-1813 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#2174 ($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. ©CDIMQpQoggn Page 1 of 1