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
Name VII:1t1L- ({,epJlEAC
Date /()h~/;O
Business Address 9 '/ '?
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Business Telephone .;23"- /r] ';).]'Ilf E-Mail 1J(i/2()vE/& ~ VI/,,/,v.r.$"~i/leRr. COh7
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before me on this I").. 11...
day of Oc-n:> eC"~ , by V I (;(J t.. Gf2..lJV~t2-. , who is personally known to
me or has produced as identification and
who did take an oath.
,\I~"',
.W~~.~. MONTE LAZARUS
( =:J MY COMMISSION # 00894772 BY: ~7-<-
.....'l'..",. EXP'~ES June 01,2013
407) 398-?;c:'., .,__..~;S',:~::;rjotaryService,com
The annual registration fee is $25.00 per l.obbyist, according to Collie nty
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# 007117020
11/2/20103:18:47 PM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
VIPUL GROVER
MARCO ISLAND AREA
CHAMBER OF COMMERCE
1102 N COLLIER BLVD
MARCO ISLAND, FL 34145-
2547
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Govt. Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Registration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Check# 6723
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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