2011/2012
J2K(J t CF(120{~
Clerk of the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, Florida 34112
Expires: / 4? /1// z..
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
2011-2012
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BUSINESS ADDRESS /6t/CJ SAw4MS5 Co~?~MrE
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Business Teleph;ne ('1 S7(J :r5"3 -/? So E-Mail .nd..r.R....nl ,'" e f / A.",e,; . c.""
NAMES AND BUSINESS ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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NAME
DATE
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ATTACH ADDITIONAL SHEETS AS MAY BE NECESS
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Lobbyist Signature
STATE OF FLORIDA
COUNTY OF ~ liiloWA~
registration was sworn to and subsc~bed before me on this the 22-da of
, 20}l, by ;;ae.J.(A,LI~ R~d" who is per ally known to
as identification and who 1 a
BY:
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 fonn).
Receipt# 007190119
9/29/2011 8:48:40 AM
Dwight E. Brock
Clerk of the Circuit Court
(r))GutJ ec-~ H (111 n ~~~C~j(0X~ 0 [P)G~
Customer
RICHARD ARKEN
GL HOMES, PARKLANDS
ASSOCIATES I, LLLP
1600 SAWGRASS
CORPORATE PKWY STE 400
SUNRISE, FL 33323-2890
1 Product
QUANTITY DESCRIPTION
1 BMR Lobbyist Registration
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
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.
UNIT COST
$25.00
TOTAL AMOUNT DUE
Check# 0235
BALANCE DUE
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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