2009/2010
Receipt# 007011020
8/6/2009 10:10:40 AM
~ tp'S/l)O/lJ
PYf '1IID
r1~DavD Cc2 ~ @ 1 ~j [Ri(~cG@ 0 [}DU
Dwight E. Brock
Clerk of the Circuit Court
Customer
STEVE NORNES
LIFE CARE SERVICES
SECOND AVENUE
DES MOINES, IA 50309
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3301 Tamiami Trail East
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
~@f}f}o@[f~f}@rr[%o @@mJD
Page 1 of 1
N~5/0 0
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name S1.z IIf Nt),~S
Business Address !- C"j..... mS1-m;I\.~1r M~
Vo-- Jlt-c----< ~. ~-c;. m;~ ~.
Date
~ -- b--09
Business Telephone ~ (Z.... l.Ci'1- 9~G
E-Mail nOfN.Se/e SNl..+.c~,
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). ~ L~~ Cc:t<..'"l 5 ~r,-.J1'Ze.S "S~ ;J~>
~ ~~
~~
9:::v
k~
r -l:. _',
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NE~
Lobbyist Signature
State of Florida
County of Collier
The fore oing registration was sworn to and subscribed before me on this .(P~ .' '.' :.... .
day of S ~ 5-. Pl>~Vle"5 , who is personally knOWl'!to.. '",
me or has pro uced N1~ 1\y1 ....... w-c.. as identification and :
who did take an oath. :
BY:
Deputy ClerkIN tary
The annual registration fee is 525.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
, '-' ....... '-~- -----