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2009/2010 ..\\.cR c00~ ~~~\ ( ~~,;:~-P\ \ \ ?L~\. \ . &;! ~1- *J 0~! OPF/-/f: C\RC0\" Receipt# 007011023 8/6/2009 10:12:46 AM 1) O?:> / CO ?lP. q/JO @H'~D@Dc~n lR~@CGc~D~)Q Dwight E. Brock Clerk of the Circuit Court Customer CRAIG DAVISSON LIFE CARE SERVICES 1301 RIVERPLACE BLVD JACKSONVILLE, FL 32207- 9047 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: BALANCE DUE: AMOUNT $25.00 $25.00 ($25.00) $0.00 ([;i;@17[jO@9rr(Q;[j@rrfko @@[{[fD Page 1 of 1 b 03/VD Board Minutes & Records 3301 Tamiami Trail East Building F, 4th Floor Naples, FL 34112 Expires BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM , Nam~A/7 2//tv/~6'<-1 Business Address /~ / ;(/y~~ , t../;f-X ~N. ~'V2d/ Date r;9. ~. of ~VD. #E2m Business Telephone fJ;f; ~~. tb~~ E-Mail ~V""~.on ~;'/,.,~~ h .t:'~ NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). (r/r=~ ~ ~v/~5 2). PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY State of Florida County of Collier BY: . Deputy ClerkIN tar):. if" f.. , I,) The annual registration fee is $25.00 per Lobbyist, according to Collier County:.. ',~ ...'. j I ,. \' ~ Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance2001~2~f,' ..' 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).