2009/2010Receipt# 007035276
11/20/2009 9:17:49 AM
Dwight E. Brock
Clerk of the Circuit Court
2F i yo j 0 0 In�II o Q Q o
DeDUtV Clerk Clerk Offic
JOELKESSLER
585 PARK ST
NAPLES, FL 34102-6611
BMR CASHIER
MinutesandRecords@CollierClerk.com
239-252-2646
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# 28535 ($25.00)
BALANCE DUE: $0.00
Ca Page 1 of 1
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
ro
ExpiresI I I
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Date /,/-.2o- 0
Business
Business Telephone
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1).
W
10 Y
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
obbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this C;" - \
day of by who is personally known to
me or has roduced 4 tvS LIC as identification and
who did take an oath.
Y:
putt' 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).