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2019/2020 Collier County Clerk of Courts Expires I g0(}-1 3299 Tamiami Trail E. (Clerk's o ce only) Suite 401,Bldg.F, 4th Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS_ LOBBYIST REGISTRATION FORM NameMatthew R. Holliday Date07/21/2020 Business Name NCH Health System Business Address 350 Seventh Street, North City Naples State FL Zip Code 34102 Business Telephone 239-826-7864 Contact Person Self Lobbyist E-mail matthew.holliday@nchmd.org 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 NCH Health System 2. Name Address 350 7th St., North Address City/State Naples, FL Zip 34102 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 (J ` day of 9 U 5t 2020, by Mt gi R{o R1(d Personally Known ; Jrotar Produced ID I. _ mycowitssloN ePublic Te of ID ProduceddnwNoY Revised:08/2019 Receipt# 008246686 8/6/2020 1:33:15 PM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller 0 gig g Customer Deputy Clerk Clerk Office Location MATTHEW R. HOLLIDAY BMR CASHIER Collier County Govt. Center NCH HEALTH SYSTEM MinutesandRecords@CollierClerk.co Building F, 4th Floor 350 7TH ST N m 3299 Tamiami Trail East, Suite NAPLES, FL 34102-5754 239-252-2646 401 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# 101061184 ($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. ©0a8@G'@OQ113BZoC0B Page 1 of 1