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2021/2022 69q Collier County Clerk of Courts Expires licedU4d- 3299 Tamiami Trail E. (Clerk's only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM 'J/) COW(AY? rf -� nName / /� Date �! t !� U Business Name mamczyie LawRie-ryi , Business Address //39 ci&J(eV i L £t 6to 20' ` r�%�i� 3` /E3 City Na )ti�,� State - Zip Code 3IJp 3 Business Telephone (221)03 '(pt q Contact Person7Iiflfl(1DI1et(--- Lobbyist E-mail bi41-tAly ad /kavAn'i -& 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 Clerk of Court. (Mail to the address listed at the top of the form) NAME AND ADDRESSI j�OF EACH CLIENT/ENTITY REPRESENTED: 1. Name Q� L Or I • .l'-dame AddretJS C err eL d%Y. Address City/State Zip ��� City/State Zip —.34103 3. Name 4. Name Address Address City/State Zip City/State Zip (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida County of Collier ?-)1/.14-407r7710 t ; . Lobbyist Signatu e a zYr. TW' registration was sworn (or affirmed) and subscribed before 41e this 4 Ai day of, AA, 20 (.7--by L 1 Via, 4 r° f P �+• Personally Known BY: • Produced ID Deputy Cler •Iii Type of ID Produced Revised:08/2019 Receipt# 008593830 7/12/2022 8:01:13 AM c���,4RCt,�TJ Crystal K. Kinzel Clerk of the Circuit Court and Comptroller o_ o - o 0 GFTHF.CIRlJ`�COJ� 0 O 0 jDHa Customer Deputy Clerk Clerk Office Location MARK ADAMCZYK BMR CASHIER Collier County Govt. Center ADAMCZYK LAW FIRM MinutesandRecords@CollierClerk.co Building F, 4th Floor 9130 GALLERIA CT m 3299 Tamiami Trail East, Suite NAPLES, FL 34109-4380 239-252-2646 401 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 2 BMR Lobbyist Registration $25.00 $50.00 TOTAL AMOUNT DUE $50.00 Original Balance: $0.00 Check#4331 ($50.00) BALANCE DUE $0.00 Note: 7/12/2022 8:19:18 AM BMR CASHIER: CHECK COVERS FEE FOR: MARK ADAMCZYK AND BRITTANY COWAN 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. ©®[ffigTa®IltZoggn Page 1 of 1