2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
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BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Name C "r, , S' +"-f to G Il ~ . - Date 2. '6 J"" '" II
Business Address 5 '\- 5 7 Go\.t<-^ Co \c.. 1'\Cw[ 'S, '[ ") W'i::'T
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Business Telephone 2- 3 i- ~1 7 - c;Z )0 E-Mail C. <;t~~~(1\ S e eJ.e IJ {trOt). (ofYI
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
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(pLEASE A]T ACH ADDITIONAL SHEETS, IF NECESSARY)
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State of Florida
County of Collier
~: :~r~ing registration ~~E-t't>tn~~ be~o~~:~~~:~~~to
me or has produced ~ as. identjfi'f~tion~d
who did take an oath. "",o:~~I\'S"1~};;>;""f
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BY: / ~ . ;';:-;{:'..1~
DeputyC
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The annual registration fee is $25.00 per Lobbyist, according1Q,(J.. ':fC~.
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and 9rdilJj1n~2
Please make payment and mail to: Collier County Clerk of C;:ourls or,
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form):
Receipt# 007170573
6/28/2011 10: 11 :00 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer
CHRIS STEPHENS
EARTH TECH
ENVIRONMENTAL
19184 MURCOTT DR E
FORT MYERS, FL 33967-
3756
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:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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