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2020/2021 Collier County Clerk of Courts Expires 3299 Tamiami Trail E. (Clerk's ffice only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name I'1/1l l.Vluu VIAutoit, Date C6 3l(off I at)a I Business Name 9(, c CI,Y tkJt. IA- U(,l u au,l I vl ( Business Address I'3(aU VY\LOT\t AN UAW-t SLu Lk 2 0Q) City r/tJ f, mutu, State AjjY)'(,I`k_ Zip Code 3-5 cl t'a Business Telephone (IT'l 11-1 WO Contact Person L(kt.,t,6i.1)I1 (AWIUYI,Vl Lobbyist E-mail I(Y11V.i,VY\ ( )9(AM(kt/tLLGA,.mil' 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 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 77),&14.../ Lobbyist Signature This registration was sworn or affirmed) and subscribed before me this day of, 2001 ,by pit Cl/100 e ys personally Known BY: Produced ID _ _ _ De _tyClerk/1\19ta4 Type of ID Produced , . NANCY BOLING 4 '?• l•� Notary Public-State of Florida I • o`: Commission#GG 331510 '\brc.... My Comm.Expires Jul 26,2023 Revised:08/2018 Bonded through National Notary Assn. Receipt# 008349589 3/15/2021 9:08:43 AM O��FRc(//�ryT Crystal K. Kinzel Clerk of the Circuit Court and Comptroller ( c=1 _ @_ ER _ _��� 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. ©gliin@112@p@@OC'�'"]M Page 1 of 1