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2011/2012
Collier County Clerk of Courts Expires 9//c7bt i3299 Tamiami Trail E. (Clerkffice only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name G/Eh.h \/• 7 /,)X Date /1/31// Business Name Business Address Lid/ •1. M rwi44;pr )21. City H 1 efic- State Zip Code 300( (p Business Telephone t0c-i _ 7fl- 304 Contact Person Lobbyist E-mail J/Ek1YJ. rix @j444/ (• Ceiwk 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 I's7Er° CaV3 cJ/ o4' C'o+1»•lu4 2. Name COW Erv44cy o Sw +4.04 Lc {r 3 Address Address City Zip Code City Zip Code 3.Name -l" ► S-f a"IC-5 4.Name VG'r Off- Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) • State of Florida /.�1: .01f.% t`,,:,• ,,,,,, ` County of Collier ■Lobbyist Signa .; `�.�•"'••.. . This registration was swo (or of ed) and subscribed before me this : c#a •ef 1\)tl\ , 201, I ,by rr- ti--k�( ^c y a CJPersonally Known BY: �•. • Produced ID n � hh-- Dep Cle ofary Public Type of ID Produced l� V, Revised:08/2011 Receipt#007199635 11/3/2011 9:09:53 AM , Dwight E. Brock Clerk of the Circuit Court I,.i a - TiCiZf f lEn_j _E _ - a a F2-7 ED Customer Deputy Clerk Clerk Office Location GLENN RIX BMR CASHIER Collier County Govt. Center 4218 N MOUNTAIN RD NE MinutesandRecords @CollierClerk.co Building F, 4th Floor MARIETTA, GA 30066-2454 m 3299 Tamiami Trail East, Suite 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 Cash Tendered ($40.00) Cash Returned $15.00 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. ©DD121Qil( ggn Page 1 of 1