2009/2010Receipt# 007035278
11 /20/2009 9:19:11 AM
CL
GI
UGLIESE BMR
585 PARK ST
NAPLES, FL 34102-6611
Dwight E. Brock
Clerk of the Circuit Court
Clerk
\SHIER
MinutesandRecords@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. (:enter
Building F, 4th Floor
3301 Tamiami Trail East
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# 28534 ($25.00)
BALANCE DUE: $0.00
Page 1 of 1
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name &r16 v *9i it'. 11 t f-L Date
Business Address
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Business Telephone X/U-�- E-Mail !q 4nmryJY
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
Lobb ist Signature
State of Florida
County of Collier
The foregoi g registration was sworn to and subscribed before me on this _--
day of - , by , , who is personally known to
me or has produced as identification and
who did take an oath. i
Deputy Clerk/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).