2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
Expires
Business Telephone 2"3 C{- L; 3g ,-r4.Sb
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Name
Business Address~ J l L Z- c
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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2).
(pLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
Lobbyist Signature
State of Florida
County of Collier
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The fO'.#:, ~gistra\~n was sworn to and subscribed before me on this d-l .' ,." "" ......
day of .1 101\ ,by , who is personallyknmyn'to '/1,,>,,'
me or has produced -F" L ~ as identification and ," '..,.,', "
who did take an oath. . " '<---
The annual registration fee is $25.00 per Lobbyist, according to Collier Coun " .
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).
BY:
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Receipt# 007154422
4/21/2011 8:50:22 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
ALBERTO QUEVEDO
LA PLAYA GOLF CLUB
PO BOX 110422
NAPLES, FL 34108-0108
Deputy Clerk
BMR CASHIER
M inutesand 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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