2009/2010
Receipt# 007061547
3/19/2010 3:01 :40 PM
Dwight E. Brock
Clerk of the Circuit Court
@VVO@]CillO I ~C~CGC~D~)Q
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 't (~I1l
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name l-diLr/e- /l}aCdol7dJc! Date ;2/ ~;;o
, ,
Business Address d g 3 :Jrd Sf ~ S"'-fe:. cJ-o/
~f- Pcl?r.sf;ur:; Pi- 3370/
Business Telephone 7 ~ 7 -?,J 3 -3.ff'f E-Mail / lna.-edolJald f) c1e-fc'/Jder.f'. Or:J
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
t). lJe~de:rJ' ~I' Midi/ie
0733 3rd :;-1. Ni S+e. dol
~1. Pe+ersbur~3} FL- 3370 I
betender.r 0{ Wddkfe
2). ri
/130 17i(lS-f, tJw
tUaShi hq-l-oV) b (! d, 003 ~,
PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
~~
Lobbyist Signature
State of Florida .
County ofC'aIJ;e:.: t>Jndl.l:\S
The fOreg~t;~t~ was sworn t9 a~ribed before me on this \ ~ ~
day of D, by LailYlL k. crDcnaJ~ho is personally known to
me or has produced as identification and
Wi}(;" did take an oath.
Deputy rkfNotary 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).
~,":.y.~ PAlGEG.HAAPER
*.. . 1< MY COMMISSION # DO 798813
EXPIRES: June 29, 2012
~~OHl#'~" Bonded 11wu 84JdgIt NolIIy s.w.
BY: