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2017/2018 ,11 Collier County Clerk of Courts Expires /20 te 3299 Tamiami Trail E. (Clerk's Office Only) Suite 401, Bldg. F,4th Floor Naples, Florida 34112 COLLIER COUNTY LOBBYIST REGISTRATION FORM Lobbyist Name L.-hri k et/ 1) /-170/S Date 7710/2 c,i 7 Business Name 46r,if( CAV\ Zit le:lc"( t Business Address 13"-) Rd rk:1 City itinuj-csvl State J A Zip Code 2 Z- 2 01 Business Telephone -2 C -32.0-) Contact Person Lobbyist/Contact E-mail 1:1 (2 11 1 c.v.-.Ce..)'-:s-.) - Notice for Lobkvists: The annual registration fee is;25.00 per Lobbyist,per Collier County Ordinance No. 2003-53,as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts(ADDRESS ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1.Name A yy‘e_fs C(Avi '1-ev k 4-7 2.Name Address \-*" t JCc.,......r-Vvv-AL (2 ssr.ito Address City Ar)IVIC)1"v/1 Zip Code 2- City Zip Code 3.Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier Lobbyist Si ure This registrati9p was sworn(or affirmed) and subscribed before me this \ day of -ji) 20 k , by Cii\i- Ovil Personally Known BY: 'NT, WcirIPT\ .?Y Produced ID Deputy Clerk/Notary Public Type of ID Produced N- Revised 08/2014 Receipt# 007813759 7/11/2017 8:31:45 AM �4v1=�<tiT Dwight E. Brock Clerk of the Circuit Court Crs cta0 ffET- _ C-L _ Customer Deputy Clerk Clerk Office Location CHRISTOPHER D. HUDSON BMR CASHIER Collier County Govt. Center AMERICANS FOR MinutesandRecords@CollierClerk.co Building F, 4th Floor PROSPERITY m 3299 Tamiami Trail East, Suite 1310 N COURTHOUSE RD 239-252-2646 401 STE 700 P.O. Box 413044 ARLINGTON, VA 22201-2961 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check#265 ($25.00) 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. ©Qo 0011@TCQQ c, 00Efa Page 1 of 1