Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2013/2014
Collier County Clerk of Courts Expires /i 3299 Tamiami Trail E. (Clerk' office only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 "r t �43 ORIDA BOARD OF 3)YY9 MISSIONERS LOBBYISTc �T:�TTSTRAt4ON FORM 1` CuURTS Name /e /� ) Date / / / 3 Business Name ZO, /,�i . G(_%1-6 ! /A/AW S lR IS.00 AT/eV Business Address 3200 Bid/./ SCC./ City it)APLC S State FL Zip Code Business Telephone 2'3/. 7-..5&7 . (P (vG Contact Person ,k177// 2(g 4 7 LCD Lobbyist E-mail /7 17/y << /./-/ - // Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name d Birk 2. Name 32 4'/ee/ If'� Address //�5'j'i-fe //D Address City ��/t6'.S Zip Code -y/b- City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) —*/ State of Florida County of Collier /� .1��-1 1 '• 4 1 lobbyist Signature • i i tt, n a "3 T is registration was swo (or of rmed) and s bscribed before me this 3 "S ;a� c ^'$ i �;J �� -_.l • a• r , 3 , by � . try � •. - ., • = ® • BY: (\idLOA Personally Known 41° Deput De �� otary Produced ID p �! y Public Type of ID Produced Revised:08/2011 Receipt# 007391497 10/31/2013 3:36:59 PM Dwight E. Brock Clerk of the Circuit Court ffcj J Customer Deputy Clerk Clerk Office Location KATHLEEN CURATOLO BMR CASHIER Collier County Govt. Center COLLIER BUILDING MinutesandRecords @CollierClerk.co Building F, 4th Floor INDUSTRY ASSOCIATION m 3299 Tamiami Trail East, Suite 3200 BAILEY LN STE 110 239-252-2646 401 NAPLES, FL 34105-8524 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#30461 ($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. ©ODD gT©ii® @CM Page 1 of 1