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2020/2021 Collier County Clerk of Courts Expires O ` ��f 3299 Tamiami Trail E. (Clerk's nice only) Suite 401, Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name A1dJ AO0CI✓A\T Date ( ' l(Dcl (D la a I Business Name IQCC 0IVW�(L.i VlSc o(A CS I \t&t. Business Address u.I'Y U OU l 1 S 'MA U( 1 ? A.A V. 100 City ti,� �yd.1/S State (/[0d1'(k(A. Zip Code '1Y,t1 I Business Telephone n(11 'el-LA COO' Contact Person UAW-0k S1 t 9&\mUwc (A 1 Lobbyist E-mail ( nck4w vaAckat ll..in.[ Notice for Lobbyists: The annual registration fee is 525.00 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 Crystal K. Kinzel, Clerk of Courts (ADDRESS LISTED ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name 2. Name Address Address City Zip Code 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 a Lobbyist Signatur This registrati w�aIrn II�s sw 1o1• (_or ffirm ) nd subscribed before me this (�l4 day of, Melia) , 20a( ,by y tAJQC)�✓(i( �rsonally Known Produced ID Deputy Clerk/Notary u Type of ID Produced 10"y� "r NANCY BOUNG , Notary Public-State of Florida ` Commission#GG 331510 Revised:08/2018 9 . 01 My Comm.Expires Jul 26,2023 bonded through National Notary Assn. Receipt# 008349589 3/15/2021 9:08:43 AM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller • yi I@I - -��@@IjD1 llt'(IRI Customer Deputy Clerk Clerk Office Location B.BROSIOUS, D. BMR CASHIER Collier County Govt. Center CAVANAUGH, L. EDINGER, S MinutesandRecords@CollierClerk.co Building F, 4th Floor JOHNSON, M. MYERS, & A. m 3299 Tamiami Trail East, Suite WOODRUFF 239-252-2646 401 PASSARELLA & P.O. Box 413044 ASSOCIATES, INC. Naples, Florida 34101-3044 13620 METROPOLIS AVE FORT MYERS, FL 33912-3406 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 6 BMR Lobbyist Registration $25.00 $150.00 TOTAL AMOUNT DUE $150.00 Check#026423 ($150.00) 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. `= CADUIT©1:1@ g Page 1 of 1