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2011/2012
Collier County Clerk of Courts Expires 3299 Tamiami Trail E. (Clerk' office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name 'IrO/7 RARt , fr Date /...2//3/26:// Business Name ?itc 71-41 * Business Address vao At, " `�'v City /$2z/f State_fa., .fa. Zip Code f0� Business Telephone`37 405— 0� -Contact Person ,))/ te r kik Lobbyist E-mail ',/Rifr a..) 0,1-440:574,(d�1 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 f%'/ 4 7& Read, r1 _• Name Address �} 2( At10 '/O - Address City >Y , Zip Code212..._ City Zip Code 3.Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) • State of Florida or011friltil County of Collier Lob. . _nature This registration was sworn(or affirmed) and subscribed be re me this 1‘..31-1/4'\ •:y of, g � n , 20�,by Personally Known BY: if Produced ID Deputy Clerk/N• . P b'is Type of ID Produced Revised:08/2011 Receipt# 007208626 12/13/2011 10:21:08 AM <<,�: �i; Dwight E. Brock Clerk of the Circuit Court G( 1-;„ ';,,,-, ( r--)) ty- 0) 01, rL---)- pf x,i (iii - --\\ ---'7„__,Customer Deputy Clerk Clerk Office Location ANTHONY PIERS, JR. BMR CASHIER Collier County Govt. Center WOODWARD, PIRES & MinutesandRecords @CollierClerk.co Building F, 4th Floor LOMBARDO, P.A. m 3299 Tamiami Trail East, Suite 3200 TAMIAMI TRL N STE 200 239-252-2646 401 NAPLES, FL 34103-4108 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. @®DDnQ [1®dho©Cala Page 1 of 1