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 31,/)/lJbECr.lllt1~ Date fhJj;/
Business Address ? () f5;;x rA~f ' ~-/ J{J Lj J-::2-
/Util'- -CSt' FL ?flog
Business Telephone :J?/I $25-/679
E-Mail 6SEO.?lJfJ?-t!iJliAf tAP,46;;LJ:: CCJ'7
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). SEL~
2).
(pLEASE A TT ACH ADDITIONAL SHEETS, IF NECESSARY)
State of Florida
County of Collier
The fore oing,registration was sworn to and subscribed before me on thiS......r!)!'5,f..,~"..
day of LO, by , who is per~oilaHr.known.to .
me or has roduced L a~ iden . fication and'. .-
. . y..... -
who did take an oath. . .;:
BY:
Deputy Clerk/Notary P
The annual registration fee is $25.00 per Lobbyist, according to Collier Co nty
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 00
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# 007154419
4/21/2011 8:44:58 AM
Dwight E. Brock
Clerk of the Circuit Court
CQ)trvn Cc:3 n &1 D [Rl@c~@ 0 C?)Q
Customer
BRIAN BECKNER
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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