2017/2018 i (A
Clerk to the Board, Minutes & Records Dept. Expires '#)
3299 Tamiami Trail East, Suite#401 (Staff use only)
Building F,4th Floor
Naples,FL 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
NameMimi Wolok Date 7/(0 LL
Business Address 1048 G ood tette-Frank Rd., Suite 201
Naples, FL 34102
2396437822 mwolok@audubonwe.org
Business Telephone E-Mail
NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
Collier County Audubon Society, Inc., d/b/a Audubon of the Western Everglades
1).
2).
(PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY)
Lobbyist Signature
State of Florida
County of Collier
The foregoing registration was swwttAbscribed before me on this
day of he ,by +++R,��• "� , who is personally known to
me or has produced0TA?1'.1•?0%% as identification and
who did take an oath. _ My Comm.Expires i
February FF 7,2529 C`d;(J L�
No.FF 955529 = ��,,,�G
J;., IBY: g
,��'•,�qr 'PUB� ���••' Deputy Clerk/Notary Public
F OF F‘10
The annual registration fee is $25. d' WrObbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24
and Ordinance 2013-39.
Please make payment to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts and mail to the address listed at the top of the form.
Receipt# 007947773
7/9/2018 1:14:34 PM
—� Crystal K. Kinzel
—.A_`_4., Interim Clerk of the Circuit Court and Comptroller
' ) o igg' g' , [D-, Lc-D, o
„„_,.,c,,,,, , ,
Customer Deputy Clerk Clerk Office Location
MIMI WOLOK BMR CASHIER Collier County Govt. Center
COLLIER COUNTY AUDUBON MinutesandRecords@CollierClerk.co BuilB29ding F, 4th 9 i Flo IrEast, Suite
SOCIETY m 401
1048 GOODLETTE-FRANK 239-252-2646 P.O. Box 413044
NAPLES, FL 34102
NASUITE Naples, Florida 34101-3044
1 Product UNIT COST AMOUNT
QUANTITY DESCRIPTION $25.00 $25.00
1 BMR Lobbyist Registration
TOTAL AMOUNT DUE $25.00
Check# 2182 ($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 o
assess or refund charges as needed.
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