2009/2010
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name~~W1 f"Gf.l . ~a. Date 1 /30/,0
f
Business Address BEC\C.82-ct lbli A-\C.OfF, p. A.
tog? N. TlCifOlne D~i'>r'S\ 1~1-&1 fJlJaY, /Nest PtL-\1Yl r~()e...'n , Fe
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Business Telephone su>1 ~ 620 - lees E-Mail IA)C.e1A @.. ~~IL..tV' )QQln^~df{.
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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1). L-.', tv!(lIA ~(r-..)L< OF ~(j\An-t ~ /)f\ \ IfI.X:, / TGct2l\/'.Js, INc,
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSA Y
Lobbyist Signature
State of Florida
County ofCelller t6/m &0(1;
The torelll/ing registratiol\ was sworn to an'!. subscribed before m~ on this 3? d
day of Ht1t!. ~ ,). 0 I U, by 11) i I J.o y' -.J ( ~c., w.. .h. 0 IS..p. ersonally known to
meorhASllfd..md _m____.. ....... ... . _.BsidentiJiCJl1iga.and
who did take an oatb.
'~U'JI""U"""""..n....,..... ..
GERY B, KO ; Ii I'
3 tft::.J(.M!.
4/21/201 .
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The annual regIstration fee Is $25.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amcnded by Ordinllncc 2004-05 IInd Ordinance 2007-24.
Please make payment and mall to: Collier Connty Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
FedEx Ship Manager - Print Your Label(s)
Page 1 of 1
From" Origin 10: PBIA (561) 655-5444
lMllicnlCea,Esq.
Becker & Poliakoft", P,A
625N. Flagler Drivll
7th Floor
West Palm Beach, FL 33401
Feclfu:1.
m1
Ship Date: 03AUG10
ActWgt: 2.0 LB
CAD: 89022201\NETJ060
"'''''......,s
Delivery Address Bar Code
IIIIIIIIIIIIIIIIIIIIII~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII111II11111
Bill SENDER
S
Ref# l116001314295
Invoice #
PO'
Depl#
EAST; BUILDING F, 4TH FLOOR
NAPLES, FL 34112
TRK#
102011 7989 0968 6024
WED - 04 AUG A4
PRIORITY OVERNIGHT
34112
FL-OS
XH APFA
RSW
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2. Fold the printed page along the horizontal line.
3. Place label in shipping pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned.
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8/3120 i 0
Becker & Poliakoff, P.A.
Check #
Vendor 10:
C0981
CLERK OF COLLIER COUNTY COURT
Check Date:
Payee
Invoice Num
314295/MJS2
314295NVJC
mrgang
Invoice Date Reference
Aug 02/10 LOBBYIST REGISTRA TION/MJS2
L 11600/314295
Aug 02/10 LOBBYIST REGISTRA TIONNVJC
L11600/314295
Totals'
191662
Aug 02/10
Payment Amt
$25.00
$25.00
$50.00
Receipt# 007098453
8/12/201012:13:00 PM
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Dwight E. Brock
Clerk of the Circuit Court
Customer
BECKER & POLlAKOFF, PA
3111 STIRLING RD
FT LAUDERDALE, FL
33312-6566
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
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Clerk Office Location
Collier County Gov\. Center
Building F, 4th Floor
3301 Tamiami Trail East
P_Q, Box 413044
Naples, Florida 34101-3044
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1 Product
QUANTITY
2
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 191662
BALANCE DUE:
AMOUNT
$50.00
$50.00
($50.00)
$0.00
Page 1 of 1
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