2009/2010
Receipt# 007040415
12/15/20093:24:11 PM
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Dwight E. Brock
Clerk of the Circuit Court
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Customer
KRISTI BARTLETT
EDC
3050 N. HORSESHOE
DRIVE STE 120
NAPLES, FL 34104
Deputy Clerk
BMR CASHIER
Minutesand Records@CollierClerk.com
239-252-2646
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# 13668
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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Page 1 of 1
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
E'p;re, 1'21>10
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Name~'(""'~ \bo...'r~\ e..-\-""
Date \"'2....\\'5 \0"
BusinessAddress '60S0 ~. ~<:::>'r~~'5y....CE- D'r, 'S""'~. \'2.0
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Business Telephone 2.CD'1>- "2FI~9 E-Mail~"""\~ ~ =\'\C>f:'\e~J;;"\.o'r\dO.
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
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Lobbyist Signature
State of Florida
County of Collier
The fo~egistratioJl.. was sworn to and subscribed before me on this I ~
day of 7 {X)r, by . who is personally known to
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Deputy ClerkINotary Public
Tbe annual registration fee is $25.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: Collier County Clerk of Courts or
Dwigbt E. Brock, Clerk of Courts (at tbe address listed at tbe top of tbe form).