2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
EXPireS~
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name~ 'r\-:=,~ \bc,....'C' ~ \ ~ -\- ~
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Business Address '~~ ~S6 ~,"'c::.Y'-se. s 'no e... \:) Y'. -s ~" \'2....6
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Business Telephone'2.'bC;-2~'1,-'iSq~~ E-Mail~'\('\~ ~ e.h~~ \~"::t9\~y.\aa...
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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(pLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
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Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was sworn to and subscribed before IJ:?e'b!itlp~"", i:3i~
day of ')A'I\~t 2-0 ~ I , by , w!Rii~~erso~M)f>l<n~wn to
me or has prod ced t- 'Lj)( ./ . .. ..., ....... . l> ~/ ~\I~ceii~fi~ti8~flI1d
who did take an oath. ....'...,'1...' '.-.= r, ;" f 1 ';...~;:. '.' .....:;.'.'.... -;' .......:....~...'...., i."}
.,;;.;): ~(": r;(;.,."'":' t... ~ ~ ......./
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BY:.~ .....~ C. ;j?'''rz...------.
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J:Jypufy(}r;t@~t~ PU~lC
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The annual registration fee is $25.00 per Lobbyist, according toCo,'llier Cotroty
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# 007130897
1/10/20111:34:31 PM
Dwight E. Brock
Clerk of the Circuit Court
CO)tlUO@OfsJrJ IJ\?'@@@D[iDQ
Customer
KRISTTI BART;ETT
EDC OF COLLIER COUNTY
3050 HORSESHOE DR N
STE 120
NAPLES, FL 34104-7908
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# 1337
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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