2010/2011
Board Minutes & Records
3301 Tamiami Trail East
Building F, 4th Floor
Naples, FL 34112
Expires --112l4--
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name I a-JYlh1(j l--ytkJ . Date /J /ltI/d.OIO
Business Address QS 79 iU. 7J/eclo 8/t>-tk 811e1.
f\1,#.. fcJi(-- FL 31/;28 i
Business Telephone q'lf - 'IX -78]r:? E-Mail -tI jd~U~(WJ ~&. ,
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). CO U ~e{' ~ () (~ LLC
1 tJ i 5r(~ck.JR ~ue S'\Ai Ie. L/Odij
m;(/L~; FL 33/3 (
2).
PLEASE ATTACH ADDITIONAL SHEETS IF NECES ARY
State of Florida
County of Collier
The f~~ regiJ!lpw>lI-Was sworn to and subscribed before me on this .J ~
day of L-e.vvr...;or ':B~ j , who is personally known to
me or ~as produced p, -/ as id~~~iV(~~t~on and
who dId take an oath. ';.- _ '. 't.-. '
"., .'
.,:,~ .'
. :.:.'
BY: .
~:. . ~. \. ~,,' ~i\'~';" '.... : .(~';
Deputy Cleo . . . : . .,;' bHc ,>;'
<.' -.i> ...
The aonual registration fee is 525.00 per Lobbyist, according to C01u$rCOH'~)~' .
Ordinance No. 2003-53, as amended by Ordinance 2004-0~ and Ordjnj&cQ~1-24. .
Please make payment and mail to: CoJUer County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
Receipt# 007125683
12/14/201012:53:40 PM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
TAMMY LYDAY
2579 N TOLEDO BLADE
BLVD
NORTH PORT, FL 34289-
9327
Deputy Clerk
BMR CASHIER
MinutesandRecords@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:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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