2010/2011
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
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BOARD OF COUNTY COMl\1ISSIONERS
LOBBYIST REGISTRATION FORM
Name ~E:.-ff.-P-i:-'t 12-, -\:J-1 ()-"c"'\.
Date s fILl) 10
Business Address
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Business Telephone 2. "I rc,- b "Zt.. I I') :s
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATf ACH ADDITIONAL SHEETS IF NECESSARY
State of FIGrida
County of Collier
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re istration was sworn to and subscribed before me on this (f~.',.,{.....:",<"
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, who is pers~nall~ ~~~.wiiJo;:"<:" .;..: ,;~.:,~
as IdentificatIon and . .;'Ji-if:
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Deputy ClerkINotary p.t:! ...'...... r-"
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The annual registration fee is $25.00 per Lobbyist, according to ColUer COD '"Ct E;' ,
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-2,t'
Please make payment and mail to: CoJlJer County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
The foregoi
day of
me or has pro uced
who did take an oath.
, by
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Receipt# 007105741
9/14/20109:19:52 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
JEFFREY JOFINSON &
JAMES BROWN
ROETZEL & ANDRESS
850 PARK SHORE DR
NAPLES, FL 34103-3587
Deputy Clerk
BMR CASHIER
Minutesand 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
2
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 909977
BALANCE DUE:
AMOUNT
$50.00
$50.00
($50.00)
$0.00
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