2009/2010
Receipt# 007037418
12/3/20098:40:44 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
WILLIAM L. BARTON
605 PALM CIR E
NAPLES, FL 34102-5558
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Gov!. 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:
Check# 525
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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Page 1 of 1
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Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name ~1,LLd~tVf L. 6 AiZ..TotJ Date /O/ZO/o9'
Business Address ~ 0 5" P f} L 1-1 C f?- . E.
tV A PLES, FL 34(02-
Business Telephone 23'1- &,4-1- ;'14-1 E-Mail hi (( bo...-.f-on 3'fe> cOMedo ne-l-
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
I).
OLDE f=LOt2-IOA ~ot-F
CLoE>, INC.
.
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
~~
Lobbyist Signature
State of Florida
County of Collier
bsc "bed before me on this 3VV<
, who is personally kno,~""",
as ideQli1!caiiolt(and" .,'
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Deputy Cle ~ ',' ie51 0 ~Yif:)
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Tbe annual registration fee is $25.00 per Lobbyist, according to COUieF.pMiIlb', " ,l,"-;,:',"~
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinad<;e 2007.24..:., <.:
Please make payment and mail to: Collier County Clerk of Courts Or ' '" ;' ' ~".,
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Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form). '"".",,-
BY: