2020/2021 Collier County Clerk of Courts Expires L' c
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 e4" - c.c �b5 Date 4/z 212oa/
Business Name (r'eai4 l � - 25 ` j L LC_
Business Address 3 S'C k or-(ecty 5+, SL, , 1 e_, l OCCO B
City C Le-/tro p State IL Zip Code 6(�6 S'f
Business Telephone 84 7-(6, 0-I O(4 Contact Person 6-'-evpN Jc,too(p 5 e,ti
Lobbyist E-mail 5J cfLe.o65 ecv C t-- -[-I.- '.e C.CH
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, Ordinance 2007-24 and Ordinance
2013-39. Please make payment(s)to: Collier County Clerk of Courts & Comptroller.
(Mail to the address listed at the top of the form)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name e.veh act()65eA) 2. Name BVy3DYCiocccp,) 2 c )
Address 3 7 O 1 J Or-A thA 5 Sf Address 12 55- i v,-, e,,- p.;Ne Q
City/State C1.1<640i r! . Zip 606 5-1/ ,3
1/ City/State Mak50 ,1).1_L Zip 5 3717
3. Name 4. Name
Address Address
City/State Zip City/State Zip
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of-Necklet-
County of-Collier
�-N.. obbyis ' ature
This registration was sworn (or affirmed) and subscribed before me this AQ" day of 0, ')
20 1 by ,v Gc c bst 1-)
Personally Known B
Produced ID ' DeputyClerk/Nota blic
Type of ID Produced L( I I ()0 7 5 Dn vi?rS LCC(.(\s,€ "OFFICIAL SEAL"
LAUREN D MARTINEZ
Notary Public,State Of Illinois
My Commission Expires 02/06/2024 Revised:08/2019
Commission No.908088
Receipt# 008378228
5/3/2021 1:55:31 PM
Low\\F.R COL,,v)x Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
\P?JIECY O —
CC_ PR
Customer Deputy Clerk Clerk Office Location
STEVEN JACOBSEN & BMR CASHIER Collier County Govt. Center
BRYSON HEEZEN MinutesandRecords@CollierClerk.co Building F, 4th Floor
GREAT WOLF RESORTS, LLC m 3299 Tamiami Trail East, Suite
350 N ORLEANS ST STE 239-252-2646 401
10000 B P.O. Box 413044
CHICAGO, IL 60654-1975 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
2 BMR Lobbyist Registration $25.00 $50.00
TOTAL AMOUNT DUE $50.00
Check#7164 ($50.00)
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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