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2004/2005 tf-L/ sg 50 County of Collier CLERK OF .THE CIRCUIT COURT COLLIER COUNTY COURTHOUSE 3301 TAMIAMI TRAIL EAST P . 0 . BOX 413 044 NAPLES, FLORIDA 34101-3044 Dwight E. Brock Clerk ORIGINAL 3 :-O::7~.jE :-":'""'1' t ....... .. ,...,_,__~ , ,'- .. . .- -, --, OFFICIAL RECEIPT When Validated .': ~..t T'" -;! ~ .~ ~ 1""'"0; ~ !";j~,:'rt ';f~::J -.r- _.,_' BY: HEIDI R DEPUTY CLERK RECE I PT : 4602 968 DESCRIPTION AMOUNT NAME : BRIAN HOLLEY LOBBYIST ----------------------------- ---------- ----------------------------- ---------- PAYOR: BRIAN HOLLEY 25.00 REFNC: HRR DEPT: BOARD MINUTES AND RECORDS TOTAL DUE: 25.00 Page 01 of 01 tt-'ts-qSl) Collier County 3301 Tamiami Trail East Naples, FL 34112 Expires BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM /; N . I' . ame .J /' ( 0." ~/~ Date CJ 7/2<;/C>->" G =-- r-~ Business Address ~/ c' /6. J Y0 JQ"7. ( '...- ( , </<2 L 6 pC'7 -S:?\~. / e. tV / /~-~C~ /c::: ~ Vr /2 Business Telephone t~ C-/ ?,- 7 L 7,) E-Mail 6> '-760)// e ptc-~ (.,-) 7a,c"JL.~. ~y/ NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). /--/9/1....-:., p~, I ..... ~. <;~c.... / G "'" ," < J ~ , 2). PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY C";/-=::>~ Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this Z ~ day of " "-" ( , by -- , who is personally known to me or has produced \ as identification and who did take an oath. ~(&C The annual registration fee is $25.00 per Lobbyist, according to Collier County Ordinance No. 2004-05