2010/2011
Clerk of the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, Florida 34112
Expires:
BOARD OF COUNTY COMMISSIONERS
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LOBBYIST REGISTRATION FORM (2-- <;11 ~ / '2~o i I \
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NAME ~H~
BUSINESS ADDRESS
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DATE 1/3/ )..01/
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Business Telephone ZI'7F - S- 7-, ') - 96"5..(,. E-Mail cmE/Z.- ,:; 6 NT S Lor,. P .J..iZ '1/1/'/0(, I ~v0
NAMES AND BUSINESS ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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Lobbyist Signature
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STATE OF ~L.\ 1'8;1{),:\
COUNTY OF { ]J
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The foregoing registration was sworn to and subscri.bed
kP"'~",. , 2QJ..!.., by:r~ f)_ ~..ll, ~""
me or who has produced f(OA"d.. "'I.U~~~ l.\(~,.'r(
oath.
before me on this the l r-t '" day of
who is personally known to
as identification and who did take an
BY: ~a1M.~ ~.~
Dep Cler tary PublIc
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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).
Date / /;7 / ~o J1
Via: tA S yYJ/I-;::<_
Collier County Board of County Commissioners
Minutes and Records Department
3299 Tamiami Trail East, Suite #401
Naples, Florida 34112
Re: Collier County Lobbyist Registrations
Dear SirIMadam:
Enclosed is my firm's check in the amount of $25.00 for the fee to cover my business and
address represented before the Board of County Commissioners as of this date. Thank you for
your assistance.
Sincerely,
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597025.o00ooo.0784
Receipt# 007187734
9/19/201110:57:05 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
JOHN SULLIVAN
EMERGENT DEVELOPMENT
GROUP, III LLC
3055 TERRAMAR DR
NAPLES, FL, 34119-7702
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
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE
Check# 1003
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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