2014/2015 Collier County Clerk of Courts Expires (1-1! 2-L7/(l)
3299 Tamiami Trail E. (Clerk' office only)
Suite 401,Bldg. F,4`h Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
((7, Date I 11 15
Name : i Y� h :� �� L��'Cv'
Business Name B c L k C v A PO 1( G c"f "-
Business Address t)-9 -+u C (Sd COtY\rat v . C 2-c 0
City 'NO- v S State F-L.- Zip Code 9 t
Business Telephone 239 4;3'7701 Contact Person S j rr_-
Lobbyist E-mail SS P� ���� � VIA C
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:
A -.(sG6 i'-e, trL .
1. Name \I e vO n.,1 i (At R -t V I-ht),'2, Name
Address Address
City 1\144e 3 Zip Code 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 A.
I . .byist Sig at re """
This registration was sworn (or affirmed) and subscribed before me this '�} day of,
9 , 20 (5, by :,,''
•Personally Known BY:
Produced ID Deputy erk/Notary/Put:0c
Type of ID Produced ��
ed:0, 2611
RCIiClpilt VVI.J.7VVV-f
9/17/2015 8:48:10 AM
Dwight E. Brock
Clerk of the Circuit Court
Customer Deputy Clerk Clerk Office Location
SARAH SPECTOR BMR CASHIER Collier County Govt. Center
BECKER & POLIAKOFF, P.A. MinutesandRecords @CollierClerk.co Building F, 4th Floor
12140 CARISSA COMMERCE m 3299 Tamiami Trail East, Suite
CT STE 200 239-252-2646 401
FORT MYERS, FL 33966-5313 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.
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