2017/2018 Collier County Clerk of Courts Expires 2-0
3299 Tamiami Trail E. ((lerk's 0111 e Only)
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
COLLIER COUNTY LOBBYIST REGISTRATION FORM
Lobbyist Name ti6-1 Date t 6
Business Name /-1 ‘-e 4/7%- af...44 4 c,s
Business Address /
City State T4/7 State Zip Code 3 2-3 Pcf-
Business Telephone Contact Person /Le zi&-)1..„-A49f..\
Lobbyist/Contact E-mail )'? c6(
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Notice for Lob4yists: The annual registration fee is 525.00 per Lobbyist,per Collier County Ordinance No.
2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39.
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:
I. Name / "I" ( 2.Name
Address Address
City /1,1 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 4t.
•
•
/771Lobbyist Signature
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This xgistration was sworn (or affirmed) and subscribed before me this 2 <4...- o
tldal
20\. lb, by AA r. o L.., •
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Personally Known BY: / •
Produced ID ct D(2.
Deputy Cle otgypPttblic
Type of ID Produced
Revised:08/2014
Receipt# 007941895
6/26/2018 8:52:00 AM
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Crystal K. Kinzel
Interim Clerk of the Circuit Court and Comptroller
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Customer Deputy Clerk Clerk Office Location
EDWARD BOWMAN BMR CASHIER Collier County Govt. Center
FLORIDA PETROLEUM MinutesandRecords@CollierClerk.co Building F, 4th Floor
MARKETERS ASSOCIATION m 3299 Tamiami Trail East, Suite
1983 CENTRE POINTE BLVD 239-252-2646 401
TALLAHASSEE, FL 32308- P.O. Box 413044
7822 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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