1998/1999
Dwight E. Brock
Clerk
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County of Collier
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY COURTHOUSE
3301 TAMIAMI TRAIL EAST
P.O. BOX 413044
NAPLES, FLORIDA 33941-3044
OFFICIAL RECEIPT
When Validated
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BRANCH OFFICES:
GOLDEN GATE
4839 GOLDEN GATE PARKWAY
GREENTREE SHOPPING CENTER
2386 IMMOKALEE ROAD
IMMOKALEE
101 S. FIRST STREET
MARCO ISLAND
1040 WINTERBERRY DRIVE
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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.cOLLIER COUNTY
3301 Tamiami Trail East
Naples, Florida 34112
BUSINESS ADDRESS
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BUSINESS ADDRESS
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OF EACH PERSON OR ENTITY REPRESENTED:
NAMES AND
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ATTACH ADDITIONAL SHEETS AS MAY
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/ Lobbyist Signature
STATE OF FLORIDA
COUNTY OF COLLIER
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The foregohlg_legistration was sworn to and subscribed before ':.:7
this, the /// day of ~.-/ /Y/f ,by _&'<<61f';..~~- ~ ','
who lS personalb l\.nowntCi . or who has produced .',,'
as identification and who didt. e an oath.
BY:
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Clerk
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Please Note. 1) Failure to renew this registration by the renewal
date of October 1Bt will result in the placement of this registrant on
a nstatus unknownn list. 2) If one wishes to revoke this
registration, a nLobbyist Withdrawaln form must be filed with the
Clerk to the Board. 3) Annual Registration Fee is $25.00 per
Lobbyist according to Ordinance 99-22