2012/2013Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 41h Floor
Naples, Florida 34112
Name
Expires
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Business Name L-( ! Ajrr
Business Address
City Nf,�_ ! rJ State
Business Telephone Ag 6 Contact Person
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Notice for Lobbyists: The annual registration feelis $25.00 De_, r 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 LC14Zi X r 1 LM-4n) . L_l. G
Address lDy 1 S 1)& M►kt g!!_j%ft5
City �M f-� Aj,e_L— Zip Code 3 39 �o�•
3. Name
Address
2. Name
City
4. N
City Zip Code City
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
State of Florida
County of Collier
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Lobbyist Signature
Zip Code
Zip Code
)T 's registration was s`� (or affirmed and subscribed before me t 's day of,
4 , 20t 5 , by ,!14 P �WAAA ft.,f4A`i
Personally Known BY:
Produced ID GAk)gtKSClerk/Notary Public
Type of ID Produced NOTARY PUBLIC
STATE OF FLORIDA
. Comma EE165476 Revised: 08/2011
Expires 4/27/2016
Receipt# 007330608
4/11/2013 8:40:36 AM
Dwight E. Brock
1
Clerk of the Circuit Court
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Customer a
Customer Deputy Clerk Clerk Office Location
DARIN MCMURRAY BMR CASHIER Collier County Govt. Center
LENNAR HOMES MinutesandRecords @CollierClerk.co Building F, 4th Floor
10481 SIX MILE CYPRESS m 3299 Tamiami Trail East, Suite
PARKWAY 239 - 252 -2646 401
FT MYERS, FL 33966 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 ($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.
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