2016/2017 Collier County Clerk of Courts Expires cu
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3299 Tamiami Trail E. (clers Office Only)
Suite 401, Bldg. F,4th Floor
Naples,Florida 34112
COLLIER COUNTY LOBBYIST REGISTRATION FORM
Lobbyist Name t tk.�r.-u „i..- c\ . Q.' N.c , _0-N,• Date )- > ) -r) ) ')
Business Name ) - ) ( w ,'r c-, ; (;,")-;>,� ".
Business Address ' b�'
`)`)- -) 71,K-v,. r N,, 1-,
City N•;-,..(--•\- State )` ) Zip Code I'`3 )
Business Telephone 'ie'-i • Cl) v ti • 22'5t` Contact Person (.1- R. `\ - u 1
Lobbyist/Contact E-mailc.:) C ), r . ; i , Q )qL, c t (
IV L-i Q,
Notice for Lobbyists: The annual registration fee is 525.00 per Lobbyist,per Collier Cou ty Ordinance No.
2003-53,as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013 9.
Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts(ADDRESS ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1.Name 2.Name
Address Address
City 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 ! �" �- '—�k� _-
Lobbyist Signature
This registration was sworn(or affirmed) and subscribed before me this 1"01-7::
illy ..0-''. 91
20( r") , by Ot,k,“ Al te---/ ,
Personally Known BY: 0),(4j r\` -
%Produced ID Deputy Cler `4.ry F.lic
Type of ID Produced D ;0-- -L4 C____--
Revised:08/2014
Receipt# 007761275
2/14/2017 9:26:41 AM
Dwight E. Brock
f Clerk of the Circuit Court
�> I 1
Customer Deputy Clerk Clerk Office Location
RAYMOND R. CHRISTMAN BMR CASHIER Collier County Govt. Center
THE TRUST FOR PUBLIC MinutesandRecords@CollierClerk.co Building F, 4th Floor
LAND m 3299 Tamiami Trail East, Suite
267 6TH ST N 239-252-2646 401
NAPLES, FL 34102-5739 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)
Original Balance: $0.00
BALANCE DUE $0.00
Note:
2/14/2017 2:53:36 PM Customer Contact ROBERT R. CHRISTMAN changed to RAYMOND R. CHRISTMAN by: Deputy
Clerk BMR CASHIER
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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