2013/2014Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4`h Floor
Naples, Florida 34112
Expires �GD' qha �
(Clerk is office Ay)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name (3AU_ M " QG���/�J = Date MA-MC H_ 1 j ZO / y
Business Name 1-10 N 6 =13 o W L-LA) 13 J3 SZ
Business Address 3 I'S f04(wU0 L.� /t f =Pin IV D 1P 2l V
City N L-L° State Zip Code '34t1 a £�
Business Telephone ;-)3 � - X78 - :20 70 Contact Person
Lobbyist E -mail �3- X ���fZ��J7�j L . C-6,M
Notice for Lobbyists: The annual registration fee is $25.00 Ver 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 CLIENUENTITY REPRESENTED:
1. Name M A640 WA PDN D (4Lt74S LLC2. Name
Address 5Qf, �.pRDj0N/ te 2D Address
City NAPLpS - f7L Zip Code 3 Y /09 City
3. Name ALL (9f C LLj e /2 r6y?jr4"ame
Address NAt PL P!9. I F L Address
CityrrCPJ eFLo`F L Zip Code`f 10 3 City
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
Zip Code
State of Florida ^r'
County of Collier
L ist Sig;atirey
This e , swo ..a* of rMER7s, 20�by o
y
__Y_�rsonally Known
Produced ID
Type of ID Produced
BY: LLtX
D putt' ler otary Public
Revised: 08/2011
Receipt# 007425325
3/4/2014 9:46:25 AM
Dwight E. Brock
t.
' Clerk of the Circuit Court
(0 0 0 0
PO
Customer Deputy Clerk Clerk Office Location
GARRET F X BEYRENT BMR CASHIER Collier County Govt. Center
LONGBOW LOBBY MinutesandRecords @CollierClerk.co Building F, 4th Floor
3115 MAGNOLIA POND DR m 3299 Tamiami Trail East, Suite
NAPLES, FL 34116 -8308 239 - 252 -2646 401
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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