2011/2012 Collier County Clerk of Courts Expires //G201
3299 Tamiami Trail E. (Clerk's office only)
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name p u r 4(ct4 Date .:V)6/( Z
Business Name Pw I �x
Business Address i S. &r�(.e`c
City naico is/MC State L Zi p Code 31111-4 C
Business Telephone 2336/ 3.37 1 Contact Person V4,...);(■ n✓&14/I
Lobbyist E-mail j,,A., 01\
Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County
Ordinance No. 2003-53, and amended by Ordinance 2004-05 and Ordinance 2007-24.
Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name /Liat_.€do Isjegip 0,,,,,,cr n-p 2. Name
C'd
1,4I4-eiee eo
Address . /Co a qJ , 00- L11`e,� RLaC1 Address
City pa TsL'b,/-LZip Code 3V'i/1" City Zip Code
3. Name 4. Name
Address Address
City Zip Code City Zip Code
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of Florida
10/
County of Collier /
I b i s4 ' nature
This registration was sworn (or affirmed) and subscribed before me this /‘ft"' day of,
re4tvaal, 20 I'Z , by k jsti rI /
Personally Known BY:
Produced IDS MONTE LAZARUS D - , i tary Public
Type of ID Produced :;p. '; • #DD894772
•�' EXPIRES June 01,2013
F'lcrideNotIr SAry'ce'Com Revised: 08/2011
(407).38:0.:53
Receipt# 007224705
2/22/2012 9:33:23 AM
Dwight E. Brock
Clerk of the Circuit Court
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Customer Deputy Clerk Clerk Office Location
ALAN BROWN (ISLAND BMR CASHIER Collier County Govt. Center
GARDENERS, INC.) KEVIN MinutesandRecords @CollierClerk.co Building F, 4th Floor
DONLAN (PUBLIX) RICHARD m 3299 Tamiami Trail East, Suite
S. SHANAHAN (RICHARD 239-252-2646 401
SHANAHAN, I P.O. Box 413044
MARCO ISLAND AREA Naples, Florida 34101-3044
CHAMBER OF COMMERCE
1102 N COLLIER BLVD
MARCO ISLAND, FL 34145-
2547
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
3 BMR Lobbyist Registration $25.00 $75.00
TOTAL AMOUNT DUE $75.00
Check# 7305 ($75.00)
BALANCE DUE $0.00
Note:
Disclaimer:All transactions are subject to review/verification. The Clerk reserves the right to correct for clerical errors and to
assess or refund charges as needed.
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