2010/2011
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
Name
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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 foregoing registration was sworn to and subscribed before me on this d..l s.t
day of A ~ ' by ~cc~ C' 6-rCU'\t_,~o is personally kno~to
me or has produced as Identification and
who did take an oat
~~\o;;.~~~ TARA FRIEDMAN ct
~: :*E MY COMMISSION # EE 055339
~~ :i EXPIRES: February 22. 2015 BY', f), " /'-
''I, Bonded Thru Notary Public Underwriters _~
Deputy Clerk/Notary Public
The 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
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
Receipt# 007154857
4/25/2011 8:51 :49 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
RICHARD GRANT
5551 RIDGEWOOD DR STE
501
NAPLES, FL 34108-2719
Deputy Clerk
BMR CASHIER
Minutesand Records@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
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 36811
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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