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2020/2021 Collier County Clerk of Courts Expires O� ��� 3299 Tamiami Trail E. (Clerk's rice only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM NameJoshua Goergen Date7/13/2021 Business Name SWFL Inc. Business Address 25071 Chamber of Commerce Dr. City Bonita Springs State FL Zip Code 34135 Business Telephone 239 992 2943 Contact Person Tiffany Esposito Lobbyist E-mail Josh@SWFLInc.com 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 SWFL Inc. 2. Name 25071 Chamber of Commerce Dr. Address Address Bonita Springs, FL 34135 City/State Zip City/State Zip 3. Name 4. Name Address Address City/State Zip City/State Zip (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier -- Lobbyist Signature This registration was sworn (or affirmed) and subscribed before me this 13 day of-S cia 20 at by 3r Personally Known Y: N Produced ID Dep ty Clerk/Notary Public Type of ID Produced tY oii`•. REBECCA DAbp WN BREWER � Nota P mi `• �, ry ublic•State of Florida t. Commission k GG 301819 My Comm.Expires Mar 1,2023 ( Revised:08/2019 ( Bonded through National Notary Asn. Receipt# 008422857 7/21/2021 8:44:55 AM ,,Rc-i Crystal K. Kinzel ("FLDTI Clerk of the Circuit Court and Comptroller nFrtirciii >‘� CD @ — — —��g- 'DER Customer Deputy Clerk Clerk Office Location JOSHUA GOERGEN Martha S. Vergara Collier County Govt. Center SOUTHWEST FLORIDA martha.vergara@collierclerk.com Building F, 4th Floor INCORPORATED 239-252-2646 3299 Tamiami Trail East, Suite 25071 CHAMBER OF 401 COMMERCE DR P.O. Box 413044 BONITA SPRINGS, FL 34135- Naples, Florida 34101-3044 7828 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check# 1288 ($25.00) 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. ©gill rigr V11®U l n\ngOriThl Page 1 of 1