2011/2012Collier County Clerk of Courts Expires N
3299 Tamiami Trail E. (Clerk's office only)
Suite 401, Bldg. F, 4tn Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name M C N D F- L o Z A i A Date
Business Name CA-;E i�N 0 C-: AtT2'- /
Business Address z Z S A 2 A S oTA C.e lti 4-e s�-- —61 d d
City S A P-A So -r - State F-L Zip Code 3424 0
Business Telephone /`f - 3 f'8 o Contact Person Ln-9 AciQ
Lobbyist E -mail ✓'a �_j La ,e 4 tN c cA r- d rt o L tr11--1
Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist. 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 CO) fie 2 Co �o-r �S * 'ee c- be- q+ 2. Name
Address l So od L t J i Ks1s4 -are C
City Zip Code 34 I 0
Address
City
Name Corse r ya-�I ayt Ca I(le 2 4. Name
Address 3 335 -7C-L ntta K4,% I -Ft Ell So (6/D Address
City ly Ce5 i, Zip Code 34112 City
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
State of Florida
County of Collier
LobbyisV Signature
Zip Code
Zip Code
This registration was sworn or affirmed) and subscribed before me this �y day of,
�(0 �
720_t( by <_aV GKrr( I& •
Personally Known
Produced ID r`#�t'l°• MEIISSAaMCKAY D u Clerk/N Publ
MY COMMISSION N DD 94W p Ty '
Type of ID Produced d EXPIRES: December 29, 2013
n,. BMW 11M Notary Public Undenwiters
Revised: 08/2011
Receipt# 007202289
11 /15/2011 11:44:10 AM
Customer Deputy Clerk Clerk Office Location
RAYMOND LORAINE BMR CASHIER Collier County Govt. Center
CARDNO ENTRIX MinutesandRecords @ColIierClerk.co Building F, 4th Floor
22 SARASOTA CENTER BLVD m 3299 Tamiami Trail East, Suite
SARASOTA, FL 34240 -9770 239 - 252 -2646 401
P.O. Box 413044
Naples, Florida 34101 -3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
1 BMR Lobbyist Registration $25.00 $25.00
TOTAL AMOUNT DUE $25.00
Check# 144611 ($25.00)
BALANCE DUE $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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