2011/2012
Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
Expires q/?DJP-
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name-J;; <5 c'1PiY' ffiAGl.-q e~4J Date q /13/ / /
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City PI. L-ItV~~% € State PlA.--
Business Telephone 9\s'''1 0;;27-7)~9 Contact Person
Lobbyist E-mail 5c,trl1, M~G)a levt(!) ~j /e.Jt . CoYY' '
Business Name
Business Address
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Zip Code :3.3&7 t
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Notice for Lobbvists: The annual registration fee is $25.00 Der Lobbvist, per Collier County
Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24.
Payments made out to: Collier County Clerk of Courts or Dwie:ht E. Brock. Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name &-ou/JM Grkre. j) lIt-z4- 2. Name
f< 0..& ~--r CRC)(.pJ AJc
Address ' l Address
City
Zip Code
City
Zip Code
3. Name
4. Name
Address
Address
City Zip Code
(A IT ACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
City
Zip Code
......,...... ................... -. .................. ........,..... ....... ..................... ...................- .... "_n_""h_U"", -..........- ............................ .... ........ .............. .. ....... .............U ................ ..n.. .................._........ .... .................._............ .............. ..U_.._......_
State of Florida
County of Collier
BY:
<J.~ regill~iqn was swo
~L-1IJct_, by
--+- Personally Known
~ Produced ID_ "-
Type of ID Produced ~ l:JL:.LIC .
Dwight E. Brock
Clerk of the Circuit Court
Receipt# 007186627
9/13/2011 1 :04:00 PM
Customer
J. SCOTT MACLAREN
STILES CORP
301 E LAS OLAS BLVD
FORT LAUDERDALE, FL,
33301-2295
CW1~r"'D ((-~~ U ({~J n [K<, (~(C~X~j U lei) G
DeDutv Clerk
BMR CASHIER
MinutesandRecords@CollierClerk.co
m
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 DESCRIPTION
1 BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE
Cash Tendered
BALANCE DUE
AMOUNT
$25.00
$25.00
($25.00)
$0.00
Note:
Disclaimer: All transactions are subject to review/verification. The Clerk reserves the right to correct for clerical errors and to
assess or refund charges as needed.
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