2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
EXPireS.
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name 7l/JI IIIERS - FLA. 711RE2ASSAS9:JC. Date LJ / ZW J
Business Address-1?I"J l54ST PI}/~ .57PJ:+T, SUI71E-J
lAKEJ.JWD FLA. 3.38tJ J
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Business Telephone .2.33 - Z8~ - 3~~ E-Mail
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). 771'tl..l:JJ.E/O.
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(pLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
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Lobbyist Signature
State of Florida
County of Collier
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BY: .::::: ~
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Deputy Clef 0' '".c c:: 5E =
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The .annual registration fee is $25.00 per Lo~byist, according to:~<J:lJ~~Ii~~n~'<"~~""6~ /
Ordmance No. 2003-53, as amended by Ordmance 2004-05 and Ordmab~e'1607..;~.:., ._--
Please make payment and mail to: Collier County Clerk of Courts or-" 7 r,',.C " ....
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the formj.' "
Receipt# 007154458
4/21/2011 9:37:52 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
TIM HIERS
FLORIDA TURFGRASS
ASSOC
120 E PINE ST
LAKELAND, FL 33801-4982
Deputy Clerk
BMR CASHIER
MinutesandRecords@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION
1 BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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