Loading...
2020/2021 Collier County Clerk of Courts Expires O I dal_ 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 &LA(U ),.0 CII/k(A(qr1 Date 31(DC1 1 a W V Business Name j(,L16(1,iUI Cu AS(Ul l U--tl.0 , I1 Vl L. Business Address 1')U 2() YYU My()l l s /+VQ.VIwt , cuA t&. lb 0 City �/UY 1'VY4,1A, State G(,()N/% (IL, Zip Code '33 i Business Telephone rJ -) opu -fr Contact Person L(,(,(, 1(i1(.)./,Q,V\yytUV Gy..1,1 Lobbyist E-mail (',(), f\j to U C3 }9(U (,l,V•L(,L( ,I'l.(. 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 �� Q County of Collier Lobbyist Signature This registra 'on was sworn or affirmed) and subscribed before me this —(�l day of, fk't,Wa (,li , 20dI ,by jel1tj c� i,, • Personally Known BY: Produced ID De ty Clerk/Notary Type of ID Produced 1 O�"'•. NANCY BOLING 1 S'f`•: Notary Public-State of Florida Commission GG 331510 Revised:08/2018 i a ,., My Comm.Expires Jul 26,2023 4 Bonded through National Notary Assn, Receipt# 008349589 3/15/2021 9:08:43 AM CO�LERCObyTL Crystal K. Kinzel Clerk of the Circuit Court and Comptroller ' !Fcty O 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. ©©[111MgEzamtagou Page 1 of 1