2011/2012 Collier County Clerk of Courts Expires `�/v2.
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 (G ZP 5. 5J Date .00
1
Business Name 41%ifli-4-° / 1 N
Business Address
State � �/ Zip Code 3 CO yJ
Business Telephone Z3 y' f: Contact Person
Lobbyist E-mail ps$l$A-d
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 /4-/Q,r J/q,(/'n O kr 6{t2. Name
8 ftM e.E.9
Address 1/c) ,. P. collier, I?fvol Address
City /-/&' a - fq,A)/) flip Code 3 r191--- 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
Lobbyist Signature /
This registration was sworn (or affirmed) and subscribed before me this / ' day of,
kgaActnl, 201 .- , by e_.L1h 9 5 r/1-4117V/4-1÷,4/./ A 2��a Notary
Before me, f') r
Public in and fc �' «�' Co aced
Personally Kno BY: o� nn personally apps
Stat f -- - first my
.: . = ►i tl�Iata fOPt l�t5
MONTE LAZARUS Qic►�
Type of ID Produc d4 " DD894772 sworn by me upon Ls oath,says that the facts
Instrument are true.
EXPIRES June 01,2013
alleged In the foregoing
(#07)398-0153 PloridallotnryService.con ��•1\ (Signed)\,���t MQTARY
Receipt# 007224705
2/22/2012 9:33:23 AM
00s66N Dwight E. Brock
Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
ALAN BROWN (ISLAND BMR CASHIER Collier County Govt. Center
GARDENERS, INC.) KEVIN MinutesandRecords @CollierClerk.co Building F, 4th Floor
DONLAN (PUBLIX) RICHARD m 3299 Tamiami Trail East, Suite
S. SHANAHAN (RICHARD 239-252-2646 401
SHANAHAN, I P.O. Box 413044
MARCO ISLAND AREA Naples, Florida 34101-3044
CHAMBER OF COMMERCE
1102 N COLLIER BLVD
MARCO ISLAND, FL 34145-
2547
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
3 BMR Lobbyist Registration $25.00 $75.00
TOTAL AMOUNT DUE $75.00
Check# 7305 ($75.00)
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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