2009/2010
Receipt# 007061547
3/19/2010 3:01 :40 PM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
MACDONALD & FLEMING
233 3RD ST N STE 201
SAINT PETERSBURG, FL
33701-3818
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
2
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 1019
BALANCE DUE:
AMOUNT
$50.00
$50.00
($50.00)
$0.00
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Page 1 of 1
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires q ! ?O 10
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name F/J'ca6efh Fi-t71Y) /11~
Business Address ~3 3 3 r cI Sf. I\J J 51 e . dO I
Sf. Pe+&SbuA--qj Fl- 33701
Business Telephone 7;)7 -3d 3 - 3gfg E-Mail ef/em ; h ~ @de.(er,derf D r3
Date
'J.-/c:; /; 0
I I
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). b-epeJ1ders- 0+ uJi/d (,.te
;>33 3rd ~1- N J Sie. d-D/
Sf. Pef-erS01AA'9 FL- 3370/
2). be+el1derf of {Ui/d kle
JI30 171h Sf. Nt~
tJafh/h{.t+OI1 be ~0030
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
.
~~
Lobb t Signature
State of Florida
County of Collier
The fO]~eg~aoon was swo~ to and sub crib~d before me on this ~ ~~
day of (, by em, who is personally known to
me or has produced as identification and
WhO did take an oathtAv ~
.0" ....~ PAIGE G. HARPER
.. . MY OOMMISSION. DO 798813
... ... EXPIRES: June 29, 2012
~"'Of~o~qr Bonded TIIIu Budget NolIIy SIMceI
Deput ClerkINotary 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).