Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2011/2012
Collier County Clerk of Courts Expires `/V /`al' 3299 Tamiami Trail E. (Clerk's office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name A P4° 0/J E S Date Business Name 00 Li I ER_ /6- ZE 'TA-i-0s' / L 1- Business Address del Po b ox 'i'700`l I City )(.1 !FS State FL Zip Code 3 y I I to Business Telephone (1 31).30 i. /5-12 :3, Contact Person bf tt pit) To k1 S Lobbyist E-mail D AM nn1 - CvCL/C72- I6L72E145 E5€Ct2 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 Ste ("8/I- �/�i^'/� /i2vl ST 2.Name JOKE- MI/t ,./E7 t i 4--/JY, G- Address ,% Fr7 Zp2icE /hIF Address PO A eV gg00/1 City /` P PI1 S Zip Code 341 alf City N, i°I ES Zip Code 3411 to 3.Name /•-4 A)//J(- ��^h UA� L-L e- 4.Name Address 3L,o 6 C1,TFIep12/5F /J E Address City //Ap/I Zip Code 3 )v City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida S ' County of Collier � Lo yist S . tore This registration was sworn(or affirmed) and subscribed before me this , a +h day of, , 20 1 , by l7u.mor\ 7-orIc Personally Known BY: <� .. Produced ID Depu Clerk/Notary Public Type of ID Produced ----- ••••••-- • er.:1,;tA IIY ODI ION�EE 135580 Revised:08/2011 I EXPIRES:October 3,2015 Bonded 1bu Ndsy Pubpc Unds wltera Receipt# 007214225 1/6/2012 1:01:49 PM Dwight E. Brock Clerk of the Circuit Court (,0 yff c e _./.-7(‘---7 Customer Deputy Clerk Clerk Office Location DAMON JONES BMR CASHIER Collier County Govt. Center COLLIER AGGREGATES, LLC MinutesandRecords @CollierClerk.co Building F, 4th Floor PO BOX 990099 m 3299 Tamiami Trail East, Suite NAPLES, FL 34116-6059 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#2548 ($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. ©CDMD®LI Lido c(�QN1] Page 1 of 1