2010/2011
Clerk to the Board, Minutes & Records Dep!.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
EXPires~ II
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Name
Date
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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2).
(pLEASE ATTACH ADDITIONAL SHEE,.: NECES~
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this 'S--tL
day of Jlu,>/L- , by /It I Nv: Wol o~ , who is personally known to
me or has produced F L-- b,.rWLrJ. tr. (. . .. f----& as identification and
who did take an oath.
uty 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# 007167757
6/15/2011 10:40 :49 AM
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Dwight E. Brock
Clerk of the Circuit Court
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Customer
MIMI WOLOK
1248 FRANK WHITEMAN
BLVD
NAPLES. FL 34103-3845
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Gov!. 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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