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2021/2022
Collier County Clerk of Courts Expires v ' it 7?? 3299 Tamiami Trail E. Suite 401, Bldg. F,4th Floor (clerk,S o ice only) Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name C` l(AA d O15 CJVAACkeJA Date OZI(Y7 I ZOR. Business Name £cOky/ So N VS [-U.-- Business Address 1 Vc�t lS 'ea gmci City i\tOJQ kS State Yz, Zip Code 3q(O 5 Business Telephone Z3c7 - I 1 - 'M7/ Contact Person C,461) OPC)11.tC cS Lobbyist E-mail 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 ke v 1(\ voy\won 2. Name Abe vjagel po0 S Address 2012 QA,tm ' ' \L Address (U7'.P T-1/1,d,.k Lc,9 Vci City/State 1J 0,143VtS } FL.- Zip 3`'f i IZ City/State NiCteVeS Zip 341 QS-- 3. Name 4. Name Address Address City/State Zip City/State Zip (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier '� \_^A — Lobbyist ><gnature This registr i n a swo ( r irm ��) and subscribed before me this � day of tcbri(q/1 20 0/9by lCAM,) 1, K • - ersonally Known BY: Produced ID Deputy Clerk/Notary Public e of ID Produced "7"4ROSEMARY McCORT Of-41KM/Ved/lii- MY COMMISSION#GG328107 �� EXPIRES:May 12,2023 Revised:08/2019 Receipt# 008521066 2/8/2022 8:16:16 AM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller y, o f_ @ _ _ Customer Deputy Clerk Clerk Office Location NICHOLAS CHIHENDEN BMR CASHIER Collier County Govt. Center EDGEWATER POOL & SPA MinutesandRecords@CollierClerk.co Building F, 4th Floor SERVICES, LLC m 3299 Tamiami Trail East, Suite 1076 INDUSTRIAL BLVD 239-252-2646 401 NAPLES, FL 34104-3621 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check#4560 ($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. ©D1111a®Tg_l@ggral Page 1 of 1