2011/2012
. -
-Collier COGnty C1erk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
Expires
1~f51-
(Cler 's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
..JA~D P:>~OvJ,J Date 10121111
Business Name ~O ~~~OtJ Et-J6 JtJeE12/tJ6- I J\JC.
Business Address '2 ~ 50 -S T AtJ FO fL.!) Co ve r
Name
City N ~ P L-ES State Ft- Zip Code 34 II 2-
Business Telephone 4~4-0 ~33 Contact Person
Lobbyist E-mail ~ brow ne JO h.,sone.'1j' GDW]
Notice for Lobbvists: The annual registration fee is $25.00 ver 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 Dwight E. Brock, Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name ~--:e. ArrAe lfEl) 2. Name
Address Address
City Zip Code City Zip Code
3. Name 4. Name
Address Address
City Zip Code City Zip Code
(A TIACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
~ Personally Known
Produced ID
Type ofID Produced
LOb~~r~
/
This registration was sworn (or affirmed) and subscribed before me this ~ / ~1'" day of,
Oefobw , 20R-, by ::r-~___ ""B.A,~ .
BY:{~ ~
NOTARY PUBLIC-STATE OF FLORIDA '---beputy Clerk/Not~ Public
...........", Patricia L. Romano \ \ - - -
~ ~ i CG~mission # DD84390S \
"",.....,.'. Exprres: JJ\..N. 23,2013
BO/'<'D!ill TIIRU ATUNTI<: BONDING cO..rne. Revised: 08/2011
State of Florida
County of Collier
Receipt# 007199026
11/1/201111:21:30 AM
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(";:'~'iiiiTi'\J.;":'"
Dwight E. Brock
Clerk of the Circuit Court
@wD@DCIDD ~@@@~D[}i)Q
Customer
BARRY SYREN & JARED
BROWN
JOHNSON ENGINEERING,
INC.
PO BOX 1550
FORT MYERS, FL 33902-1550
Deputv Clerk
BMR CASHIER
Minutesand Records@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
2
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE
Check# 18547
BALANCE DUE
AMOUNT
$50.00
$50.00
($50.00)
$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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