2009/2010
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Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires
Name
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
IlEA ~Ilvi -If Date
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Business Address
Business Telephone 17; - 971- 57110
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NEC:?, 4
Lobbyist Signature
State of Florida
County of Collier
The foreg~ registration was sworn to and subscribed before me on this ""J2,;{ ~
day of ~ f\ e ~ II ' , who is persolJ~lly known ',tt)., "
me or has produced ~. ~~ L" e.. . as jit,~nt.ifi~~t~qn and
who did take an oath. kJ:: : ~'!:: i',",
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OOC :~H
Deputy ClerkINotary'PubH<< . .' . . . .
The annual registration fee is $25.00 per Lobbyist, according to Collier 'COll.IJty,' ....>
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007~i4.
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).
Dwight E. Brock
Clerk of the Circuit Court
Receipt# 007086210
6/21/20109:24:56 AM
Customer
KEN PRUITT
10521 SW VILLAGE
CENTER DR
PORT ST LUCIE, FL 34987-
1930
(9)frvu@u~rJ r~@cc3@~~G
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:
Check# 1831
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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