2020/2021 Collier County Clerk of Courts Expires ( " (90 i
3299 Tamiami Trail E. (Clerk's frice only)
Suite 401,Bldg. F,4th Floor
Naples,Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name LCl,UJ(,1/1 ( (�1,1 IIIcity Date Co31 corgi DO a i
Business Name QCL (A(l,(,_Ct.tl (laijAkk i 1 vu_
Business Address V)Lau W ry-0\ (J\ h t V1 u_i C lM\i 2 s o
City f/try ,(yc State ctl)v Zip Code 3 3 t >-
Business Telephone ' 361 aILI (11bU I Contact Person L(,t,l .xk 1)11,14,V1 atlir '
Lobbyist E-mail ,UX t)V1 t. W y9 C�S Cut WA..A.-AI I-
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
obbyist Signature
This registra ion was sworn Lor affirmed) and subscribed before me this day of,M ,
20a ,by �d Iilc, °<✓1/
J i
Versonally Known BY: —
Produced ID Dept Orr ota , Pubhc
Type of ID Produced
( ,, ;r"aye:., NANCY BOLING
*-• �- Notary Public-State of Florida
a or Commission a GG 331510
( '''`�ov�° My Comm. , Revised:08/2018
Bonded through NationalExpiresJul Notary Assn.2023
Receipt# 008349589
3/15/2021 9:08:43 AM
`OAF,\FR C'p �TF Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
y O o oo_ _y_•\
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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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