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2020/2021 Collier County Clerk of Courts Expires 0 I DO9-' 3299'Ta m i:uu l Trail E. (Clerk's o ce only) Suite 401, Bldg. F,-1'h Floor Naples. Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name 0_1' �'t t n J `� Date 12 70'Z / Business Name cQ Business Address 18 �� e City l • ! )1 4' State Zip Code 229D I Business Telephone Z-3q '33z-9(0?7 Contact Person aly i 111 t l i Lo Y Lobbyist E-mail ___c_k_(1 f'I(')Ct—, 1'`+ tot ! (..Q r lam'" 4- (o CO Notice for Lobbyists: The annual registration fee is S25.00 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. (X1ail to the address listed at the lop of the form) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name � �i 2. Name Address /D 0 t�(pp11\_Q✓5 2 a Jet . Address City/Stater no r'xa..ck1 a-Zip .33'4DE5 City/State Zip 3. Name 4. Name Address Address City'State Zip City/State _ -- Zip (.u•1.,(i t Ann!"IONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier �nO _ /le P- Lobbyist Signature This registration was w (or affirmed)and subscribed before me this /a day of 1fl j 20 at by 0 1.t44.) �r .- Mc l('-'e" Q,� (/Personally Known \_,�N�A 11100/01,_ BY: ?DA A - tz �'^-2 4. Produced ID ��� 5. . .. 04 DeClerk/Notary Public Type of ID Produced �� �o��ssioN�rp� '9 27,20 • * • •• * = Revised:08/2019 tiGG 987421 `y Q 1 Oj .::,0nded Ocece.•.9' -1 •.public... F< ///////,/S1t1 iSlP o\\\\\\\ Receipt# 008385536 5/13/2021 1:35:43 PM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller ).) �mP0��FT - }DER Customer Deputy Clerk Clerk Office Location SCOTT SCOVILL, BMR CASHIER Collier County Govt. Center CHARLOTTE R. MILLER, MinutesandRecords@CollierClerk.co Building F, 4th Floor JOHN RENFRANZ, BRANDON m 3299 Tamiami Trail East, Suite STAN KI EWICZ 239-252-2646 401 FPL - FLORIDA POWER & P.O. Box 413044 LIGHT Naples, Florida 34101-3044 700 UNIVERSE BLVD JUNO BEACH, FL 33408-2657 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 4 BMR Lobbyist Registration $25.00 $100.00 TOTAL AMOUNT DUE $100.00 Check# 5000640396 ($100.00) 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. ©C 11111®[F©p®ITliZo@gptia Page 1 of 1