2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
EXPireS~
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Business Address Z. Z
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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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 sw
daYOf~r/ I , by
me or has pr duced
who did take an oath.
Deputy lerk/Notary 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).
MEUSSA A. MCKAY
MY COMMISSION # DO 944430
EXPIRES: December 29,2013
Bonded Thru Notary Public Underwriters
BY:
Receipt# 007152056
4/12/2011 9:35:14 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
RAYMOND K. LORAINE
CARDNO ENTRIX
22 SARASOTA CENTER
BLVD
SARASOTA, FL 34240-9770
Deputy Clerk
BMR CASHIER
Minutesand 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# 138886
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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