2020/2021 Collier County Clerk of Courts Expires ice only)
Suite 401,Bldg.F,4th Floor
Naples,Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name 1V� %� \bVUA. t.c u Date Q)31(D C a(J a
Business Name p(kM(,,•Y tuft S l)ULU XLL\
Business Address Lin- VVIC l'Vl)V()l lS 1\v tv w. , Su,11a, 2.LA 0
City rUY l V"t4l.6 State r/l oy I( Zip Code 5 Yi I'�
Business Telephone 3'1 1-4(PQ(Q'- Contact Person LtIAYc,. 5t`
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Lobbyist E-mail S Ltylt. vcuso,vuLut- 1-
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 G
Lobbyist Signatu (��
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This registration was swornor affirmed) and subscribed before me this '"1 day of, (4(d) ,
2od1 ,by Shone 0 n c ch
1-""Personally Known BY:
Produced ID Dep rk/Notary
Type of ID Produced
;'tWY Pie. NANCY BOLING
Notary Public-State of Florida
;;;` Revised:08/2018
is Commission#GG 331510
My Comm.Expires Jul 26,2023 `
•Bonded through National Notary Assn. 0
Receipt# 008349589
3/15/2021 9:08:43 AM
Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
F THF.CIR�J`�` 0 Og—g—K Gm-y@Cc;
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.
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