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2013/2014
Clerk to the Board, Minutes&Records Dept. Expires vI (b) 3299 Tamiami Trail East, Suite#401 (Staff use onl Building F, 4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Lauren /"(CfrKrXm, Date 06/0gtilt. Business Address 1495 Smith Preserve Way Naples FL 34102 Business Telephone E-Mail NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Conservancy of Southwest Florida 1495 Smith Preserve Way Naples FL 34102 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) 07 Lobbyist Signature State of Florida County of Collier The foregoing registration was sworn to and subscribed b ore me on this day of 5t i 6 �. , by ('-,1\ r ( B I ek who is personally known to e or has produced as identification and Notary Public.State of Florida 1 y Oisl ,I My Comm.Expires Feb 7.2018 '•:;E �`d', Commission#FF 88740 BY: _ t: • 1117 # 'Iguua• Bonded Through National Notary Assn. Deputy Cler $tart'Public The annual registration fee is $25.00 per Lobbyist, according to Collier County Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Please make payment to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts and mail to the address listed at the top of the form. Receipt# 007461615 6/20/2014 3:23:52 PM _c"'.nr,J Dwight E. Brock Clerk of the Circuit Court 4 K,.,,. r- 0 ©UV C_ , 1 [R Customer Deputy Clerk Clerk Office Location LAUREN MARKRAM BMR CASHIER Collier County Govt. Center CONSERVANCY OF SW MinutesandRecords @CollierClerk.co Building F, 4th Floor FLORIDA m 3299 Tamiami Trail East, Suite 1495 SMITH PRESERVE WAY 239-252-2646 401 NAPLES , FL 34102 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# 11797 ($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. ©CAMa gl® oggE10 Page 1 of 1