2019/2020Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4"' Floor
Naples, Florida 34112
Expires `J iTA
(Clerk's Ice only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
NameAmelia Vasquez Date
Business Name Collier Building Industry Association (CBIA)
Business Address 3200 Bailey Lane, #110
City Naples State FL Zip Code 34105
Business Telephone 239-436-6100 Contact Person Amelia Vasquez
Lobbyist E-mail Amelia@cbia.net
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 CBIA 2. Name
Address 3200 Bailey Lane, #110 Address
City/State Naples
3. Name
Address
City/State
Lip 34105 City/State
4. Name
Address
Zip City/State
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
Zip
Zip
State of Florida
County of Collier
LobbyikSignature
This registration wqs sworn (or affirmed) and subscribed before me this day of v`n
20 2D by ta--yctsay�
Personally Known BY: V\ A�,— YW
Produced ID Deputy Clerk/Notary Public
Type of ID Produced 4- L- —o'Cj j
08/2019
Receipt# 008226562
6/17/2020 3:54:44 PM
',�Rco(,�TF Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
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GFTIiF. CLR�J`� Ono C(, � g� a
Customer Deputy Clerk Clerk Office Location
AMELIA VASQUEZ BMR CASHIER Collier County Govt. Center
COLLIER BUILDING MinutesandRecords@CollierClerk.co Building F, 4th Floor
INDUSTRY ASSOCIATION m 3299 Tamiami Trail East, Suite
(CBIA) 239-252-2646 401
3200 BAILEY LN STE 110 P.O. Box 413044
NAPLES, FL 34105-8524 Naples, Florida 34101-3044
1 Product
QUANTITY DESCRIPTION UNIT COST AMOUNT
1 BMR Lobbyist Registration $25.00 $25.00
TOTAL AMOUNT DUE $25.00
Cash Tendered ($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.
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