2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name J5~ \ D\)LV\~S0 V) Date L\ - C) ~ \\
Business Address \~ burni; ~~ Dr-
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Business Telephone c:.3~- -Z ~~--- '-I CXCQ ~ E-Mail5 w ~ [5' c:c~\: 5 . ~ 1-
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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2).
(pLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
State of Florida
County of Collier
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The fore ing registration was sworn to and subscribed before me on t4i{' . .~" . f/I:> ,
day of ,"1 20 I , b.JL _ , who is pe~onalry known to . '. ,'~)
me or ha produced 17.--- b7--- is id~ntific~tiion an9:~' '".- _
who did take an oath. : . :', I,.,: '
Deputy CI((rk/N9f
The annual registration fee is $25.00 per Lobbyist, according to Collier oun
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinanc
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# 007154423
4/21/2011 8:52:25 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
BILL DAVIDSON
LA PLAYA
185 BURNING TREE DR
NAPLES, FL 34105-6308
Deputy Clerk
BMR CASHIER
M i nutesand 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:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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