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2020/2021 Collier County Clerk of Courts Expires v M a091 3299 Tamiami Trail E. (Clerk's office only) Suite 401,Bldg. F,4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name h) (k,v\y AyUS1 BIAS Date 0 6\UM 12Ua t Business Name Va,cc(k&(U),L-d s UUC(,t.us, 1 a t.. Business Address r 1)(i L(Q WU-14 O M ki tlA lA L S IiU -2-4f.) City Y ►l'k YV\ k,(,S State r/l(1l(1 () Zip Code 4i'JC1 l)- Business Telephone try .-)1'I4(/OU ' Contact Person Uf Cl SI L th M (VA Lobbyist E-mail VAKYVAill 9 0 \NO C 1 f l l.kik..K.,l-k 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 tA,(J Lobbyist Sigma ture This registrat- was sworn(o affirmed) and subscribed before me this 1 ,v► day of (�j1i , 20cZI ,by l atilt6YOSLOLL! • I/ /Pe Y rsonall Known BY: Produced ID Dep ty C erk/Notary Pu Type of ID Produced -- - - - --- - - ---' 0 iii,:r Pile., NANCY BOLING I :: �: Notary Public-State of Florida o My Co Commmm-Eissi xpires on#GG Jul 331526,10 2023 Revised:08/2018 l�oFa Bonded through National Notary Assn. Receipt# 008349589 3/15/2021 9:08:43 AM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller CIVL 0 iffff o 0 00 () 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. ©0D0a®T@Ikgggn Page 1 of 1