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2011/2012
Expires al0/ Collier County Clerk of Courts Ex P 3299 Tamiami Trail E. (Cler s office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM, Name - %e2L 4S:S/P�' Date /O- /7- �D// Business Name gar/es Ac-r diSo ,A-i 7 c J Business Address PtJC 5 e.,t City I v aq Ic$ State i- L Zip Code 3 `f / O Business Telephone 239- 2(L-(cS f 7 Contact Person s- lGS,c'/-e-r' Lobbyist E-mail •,/: w /<_5S iee- .7 /1 C'I Gtr-T, 01-1 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 KG( ies 1 ' AsS ic 1 i-70►i 2.Name Address 5g S & ric & GeT Address City NI c (cs Zip Code 34/0Z- City Zip Code 3.Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier dir / ..t . , Lo: I yist Signature ��s registration was sworn(or affirmed)eland subscribed befo this;;',�.4 fr. ,,� �� +'ay of,^,�. ob-er ,20J � Eby � � ;.. ':. / 1,/_ II:,F V - �� Personally Known BY 4' _ `A �g` Produced ID ° 'Deputy-Clerk/Notary ' 1 °PP' Type of ID Produced 4/Fp. j, Receipt# 007195563 10/17/2011 2:37:20 PM ,y;.,�_<„:,-,,� Dwight E. Brock Clerk of the Circuit Court l' 1 a o o fFl2.CLK��i p Customer Deputy Clerk Clerk Office Location JOEL KESSLER BMR CASHIER Collier County Govt. Center NAPLES ART ASSOCIATION MinutesandRecords @CollierClerk.co Building F, 4th Floor 585 PARK ST m 3299 Tamiami Trail East, Suite NAPLES, FL 34102-6611 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#32315 ($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. ©glEri I V[1®LI l agg loll Page 1 of 1