2010/2011
Qt. 9/Z01(
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Date lll)( /'d-L i D
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Business Address ). J J. L C;,\. C ,,\ C<J f Lt.1T Sc .j
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Business Telephone C)"~ C1) :2') <;; - ,~clo E-Mail -to ~ t 0= tit I c'- t1 ). (1 r:-: r
Name
It.~
I>et'~~l~
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1).
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before m~ on this J. ~!,
day of ~~, by , who IS personal1.. . own. to
me or has produced <<--.:JJt l\J~ LLc... as identlGpationand'.
. .~. ,.' ~'\ \ "
who dJd take an oath. ~..':,':'f.<'.";'''-'''...,.;
',~:c.~f.""
Y: . 00 '" . ~ 0 .::.:t)(;i'
.r'.' " " _"'.
Deputy ClerkIN~l~.Y.f~lff:tI.,.
The annual registration fee is $25.00 per Lobbyist, according to Collier, Ciiunty
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
Receipt# 007125684
12/14/2010 12:55:30 PM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
TED TREESH
2726 OAK RIDGE CT STE
503
FORT MYERS, FL 33901-
9356
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 1415
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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