2012/2013Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
Expires DOI3
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Lw l\ 6M $ Date 3 �Z's I Z C> %3
Business Name
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Lobbyist E -mail 64t->t, G \ . C . � M ' V\A L,,-,-Y\ ✓ses . :�_ o 4-A
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 CLIENUENTITY REPRESENTED:
Name Le u) o a 1Pm45 , Lt_, L 2. Name
Address 1c`k- -7::,%x A.
City < Zip Code_ > >t[rC.
Address
City
3. Name 4. Name _
Address Address
City Zip Code City
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY) ,o
State of Florida
County of Collier
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This registration was swo (or affirmed) andsubscribed be
MA(2.l'- ,2013 by V SSG- l M i rt t-- .
Personally Known
Produced ID
Type of ID Produced
Zip Code
Code
me this Z day of,
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:0703
A
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ceaJG385 -7013
DEANNA J. CRAFT
•�Commission # DD 900703
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�Rf ty °,. Bunded lhru Troy Fain Insurance 800 -385 -7019
Receipt# 007330606
4/11/2013 8:39:17 AM
Dwight E. Brock
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Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
RUSSELL SMITH BMR CASHIER Collier County Govt. Center
LENNAR HOMES, LLC 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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