2012/2013Clerk to the Board, Minutes & Records Dept. Expiresx�J
3299 Tamiami Trail East, Suite #401 (Staff use only)
Building F, 4th Floor
Naples, FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Chris Hagan Date 09/18/12
Business Address 909 Tenth Street South, Suite 105
Business Telephone
Naples, FL 34102
239 - 687 -3811 E -Mail Chris @HaganEng.com
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1).
2).
To be determined
(PLEASE ATTACH ADDITIONAL SHEETS, IF
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this
day of f' (�; by (,,i LJ�IS �i� t✓ , who is personally known to
me or has produced as identification and
who did take an oa$,A PUS, VALERIE W. RICE
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* MY COMMISSION i EE 000063
EXPIRES: October 12, 2014
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eputy Cler otary Public
The annual registration fee is $25.00 per Lobbyist, according to Collier County
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).
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Receipt# 007A25
9/19/2012 10:16:45 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
CHRIS HAGAN
HAGAN ENGINEERING
909 10TH ST S STE 105
NAPLES, FL 34102 -8210
1 Product
Deputy Clerk Clerk Office Location
BMR CASHIER Collier County Govt. Center
MinutesandRecords @CollierClerk.co Building F, 4th Floor
M 3299 Tamiami Trail East, Suite
239 - 252 -2646 401
P.O. Box 413044
Naples, Florida 34101 -3044
QUANTITY DESCRIPTION UNIT COST AMOUNT
1 BMR Lobbyist Registration $25.00 $25.00
TOTAL AMOUNT DUE $25.00
Check# 1151 ($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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