2010/2011
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Date / (J Ii CJ
,7.01
Name (fqJl\
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NECES
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this
day of , by ,@ho is personally k~o
me or has produced as identificatIon and
who did take an oath. ( . .
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~. ~i Expires July 29.2013
'l,~P.f.jil.~ BondodTlvuTroyFainlnsulllnceSOG-385-7019 Deputy Cler y 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).
Receipt# 007110164
10/4/2010 11 :36:56 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
JAMES H. SIESKY
SIESKY, PILON & POTTER
1000 N. TAMIAMI TRAIL 201
NAPLES, FL 34102
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# 2538
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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