2009/2010
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COLLIER COUNTY
3301 Tamiami Trail East
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
NAME t1lck,,~\ ~ '~""",IM(,""""'tc;;.,^ DATE (0 { (q (0'1
BUSINESS ADDRESS
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NAMES AND BUSINESS ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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ATTACH ADDITIONAL SHEETS AS MAY BE NECESS
Lobbyist Signature
STATE OF FLORIDA
COUNTY OF COLLIER
foregoing registration was sworn to and subscribed before me on this the C <fay of
r- , 2009, by ./V/('.J;p-e-. / :T- ;r1?7~rn?.a::.-..... who i rsonally kno to
me or who has produced as identification and w Ole an
oath.
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: C. LAURENT :
E ",\1'"'1/111. Comm# 000689386 :
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E [~m~ Expires 612912011 E
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: -:";;'tIj$P~~ Florida Notary Assn., 100 :
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BY: ~~
De uty CIerk/Notary 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# 007027698
10/19/20098:22:03 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
MICHAEL J. TIMMERMAN
1415 PANTHER LN STE 346
NAPLES, FL 34109-7874
Deputy Clerk
BMR CASHIER
M inutesand 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
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Cash Tendered:
Cash Returned:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($40.00)
$15.00
$0.00
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