2009/2010Receipt# 007033487
11/13/2009 11:11:26 AM
02�
Customer
DAVID E. I
PBSW
Dwight E. Brock
Clerk of the Circuit Court
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482 S KELLER RD
ORLANDO, FL 32810-6130
Clerk
BMR CASHIER
MinutesandRecords@ColIierClerk.com
239-252-2646
Clerk
Location
Collier County Govt. Center
Building F, 4th Floor
3301 Tamiami Trail East
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
Check# 8056 ($25.00)
BALANCE DUE: $0.00
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Board Minutes & Records U I� Expires ZD(�
3301 Tamiami Trail East 1�ov 0 5 2009 U
Building F, 4th Floor
Naples, FL 34112(�
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
David E. Deans
Business Address PBS&J, 482 S.
Business Telephone 407/647-7275 x4104
Date 10/28/09
Rd.: Orlando. Fl, 32810
E-Mail dedeans@pbsj.com
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). Collier County Public Utilities
2).
3301 E. Tamiami Trail, Bldg. H
Health Bldg., 3rd Floor, Naples, FL 34112
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
Print or type name of Notary
Personally known Wr Produced 1011 �^
'!�4e utlD produAd & ID number L
State of Fiorfda
County of Collier
r�ry Public State of Florae St Signature
Shell C Jaoquin
My Commission DD755990
Expires OY07/2012
The foregoing registration was sworn to and subscribed before me on this
day ofy3 , by , who is personally known to
me or has produced
who did take an oath.
US
as identification and
Deputy Clerk/Notary Public
The annual registration fee is $25.00 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).