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~tI1C(~X~khent.-\fcJ:r Date 6--1:f-1(
Business Address Z. ~ s-o 'r*-r-[ Ct..V\. d (2-L
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Business Telephone z.~..... ~S-S:-S-Oz...v E-Mail Fl~Jvhe...ne..r-@ C~lV\CtVt~ t1~
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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(pLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
State of Florida
County of Collier
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The foreg ing registration was sworn to and subscribed before me on this:"k";1'~~~:'<~~~
day of Y\'L , by , who is persgp.~lly~~ci'.',;.:,}~o.>~:&
me or has produced .\=' C--- 1)L" ~8td ,rf19adbn [;lfld'~:,;!:'~'.~:v' :,~
h d'd ak h '''" . . ..t'" ..,<,,' ",-c;r, -
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BY: ~:';,k' "
...' ,. 'J.r;. .~.'
Deputy ClerkINotary Putt c)
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# 007167377
6/14/201110:28:10 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
FRANCIS KITCHNER JR.
RENFROE JACKSON, INC
2550 GARLAND RD
NAPLES, FL 34117-4001
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
~@O 0 0 @[f~O @[f!ko (Q;@[{[f[)
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