2009/2010
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
-Q)Cf' Cft 10
Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name 6ez~ M=s04: ~'i / Date ;/;(;0
Business Address /6 CI 2- Vh~ ~ h /.-~ A pL
hAf /tfl/L~.:;r) Pc 35727//
. (' 3:.,1 9 ~6"? b (; .
BusmessTelephone 2-.57~~ E-Mail ;;f!~~f~/:.WatJ!cc'/--q
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). eL?5f.4/~., &4/ /:'70AY
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
~~
gnature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this 4~
day of -?tV~' , by t , who is personally known to
me or has pro ed 'Of \ V Q.. '{"IS ""~. .,. as identification and
who did take an oath. ~ ~
uty ClerkiNotary Public
The annual registration fee is $25.00 per Lobbyist, according to Comer County
Ordinance No. 2003-53, as amended by Ordjnance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: CoJUer County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
Receipt# 007098454
8/12/201012:14:39 PM
\)fU2('I~~~
(.~r .~"\
/ .~.~"\ J \:-'\. \ '\
I \ I';
",I ,) ~,I'-i
~\ \.. ~I J~!
~1"- ~//.CI
0/>_ '_ ___<<"'...
ffJl~ eiR('-
Dwight E. Brock
Clerk of the Circuit Court
(rl '\\1' ~,-!{J:iFI (/(~~' !,~II C~:I D
~\"j) Ii !, \J71 roll
___-- ..., L _' ____..._/ '._ ~_._.-----'~.._,
Customer
SOUTHERN BIOMES, INC
1602 WOODFORD AVE
FORT MYERS, FL 33901-
2426
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
I' -', r~J ~1
") "" ~--, G - I r'y,
-~) C~ \( -,_~ n\I': (\ \ :1
!\.'" Qj' \,C=J ':;51_J J)~J
Clerk Office Location
Collier County Gov!. 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:
Check# 5977
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25,00)
$0.00
:?,:, n t7 (1".c' c-p0 !7r;'~ c-p! i-?=r;-~ r-;Y'
\~:!J!QjL/LiUI,,-S5lj 1&// ~%'L( L(\1L,I llJ~/tflIlj
Page 1 of 1