2008/2009
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Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
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EXPires~
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name~.d.-vv Date
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Business Address
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Business Telephone 2- 3 <7 7 g--'f - 5i { <(
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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TACH ADDITIONAL SHEETS IF N
The foregoing registration was sworn to and subscribed before me on this
day of , by , who is personally known to
me or has produced as identification and
who did take an oath.
BY:
Deputy ClerkINotary 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).
Dwight E. Brock
Clerk
BY: TERESA D
DEPUTY CLERK
RECEIPT: 5545896
NAME :
PAYOR:
NANCY PAYTON
NANCY ANNE PAY~ON
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County of Collier
CLERK OF THE CIRCUIT COURT
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1/09
COLLIER COUNTY COURTHOUSE
3301 TAMIAMI TRAIL EAST
P.O. BOX 413044
NAPLES, FLORIDA 34101-3044
ORIGINAL
OFFICIAL RECEIPT
When Validated
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DESCRIPTION
AMOUNT
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LOBBYIST
25.00
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DEPT: BOARD MINUTES AND RECORDS
TOTAL DUE:
25.00
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