Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
2014/2015
Collier County Clerk of Courts Expires 0°I ( I fl 3299 Tamiami Trail E. (Clerk's office only) Suite 401,Bldg. F,4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name Nt ko 1 a U S K C Si-e,y Date 5-( a -(� Business Name IUrrpL( H-c ! �} $SO�Q�p Business Address 35Sct L-yCC_k A v 3'e. City kfry 2S State t—L Zip Code ,- t C ki Business Telephone a39-643-0 ( (,Co Contact Person Lee J2 USS e (( Lobbyist E-mail +tX P2\\ -ass()CplcA-tS Cc'} 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: SEC aft-c`ck S f- 1. Name 2. Name Address Address City Zip Code Ci Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTAC t DITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier iL■=_, ob�.y' gnature This registration was sworn (or affirmed) and subscribed before me this 1 a day of, 20 I' , by N∎‘co la u S Ss-e,r\ Personally Known BY: Al S Produced ID _ Deputy Clerk/N t ary Public Type of ID Produced tiM.r''''''; LEE M.RUSSELL ,a‘ ::: MY COMMISSION N FF 032412 �•,.��: EXPIRES:October 30,2017 % Rf,O,°"••' Bonded Tiw Notary Public Underwrters Revised:08/2011 RC{rCIFLtt VV I JVJLJV 5/27/2015 2:53:59 PM Dwight E. Brock Clerk of the Circuit Court y` \ 1 o OrT 1 � Customer Deputy Clerk Clerk Office Location NIKOLAUS KASTEN BMR CASHIER Collier County Govt. Center TURRELL, HALL & MinutesandRecords @CollierClerk.co Building F, 4th Floor ASSOCIATES, INC. m 3299 Tamiami Trail East, Suite 3584 EXCHANGE AVE 239-252-2646 401 NAPLES, FL 34104-3732 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# 12856 ($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. ©®11 IlW@b gODUO Page 1 of 1