2010/2011
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\" Nipliis, FL 34112
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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Name <!/Tfhf};_AJ
Business Address Z:2 ()O
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Business Telephone 231. ?/36 ,c, /06
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
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Lobbyist Signature
State of Florida
County of Collier
The foregoi g registration was sworn to and subscribed before me on this '7 ~
day of , by , who is personally known to
me or has p duced .c-< C C:' as identification and
who did take an oath,
Btz(wU/\~r(
Deputy ClerkfNotary Public
The annual 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).
Receipt# 007166465
6/9/2011 2:54:55 PM
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Dwight E. Brock
Clerk of the Circuit Court
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Customer
KATHLEEN CURATOLO
3200 BAILEY LN STE 110
NAPLES, FL 34105-8506
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk,com
239-252-2646
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Clerk Office Location
Collier County Govt Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P,Q. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25,00
TOTAL AMOUNT DUE:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25,00
$25,00
($25,00)
$0.00
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