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2023/2024 Collier County Clerk of Courts Expires q/ 0 3299 Tamiami Trail E. (Cler 's office only) Suite 401, Bldg. F,4'Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name ) �.2__. �_ . Date Business Name Ve-c12 Business Address SO 5 S• /✓urn l f,rl 1- f/ j y� City /4'I p). w e if'� State 614- Zip Code ,?(:_)0 Business Telephone 710'3 C 2 7 Y Contact Person Lobbyist E-mail ✓l•e . C. S'✓ti. ve/a Z or,. C t)r-t Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Please make payment(s) to: Collier Clerk of Court. (Mail to the address listed at the top of the form) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name V-f l7_o r'1 2. Name Address Ste'— °4 �6Cd Address City/State Zip City/State Zip 3. Name 4. Name Address Address City/State Zip City/State Zip (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida i�� � County of Collier Lob ist Signature This registration was sworn(or affirmed) and subscribed before me this / day of, AyQ,,1,,E 20 3) ,by l i e Simi A l •���"sO N r$ ����i�i Personally Known BY: "'4� Produced ID Depu erk otary Pudic= 04© , N= Type of ID Produced R,= 1 u �,pFG „iqunmm�%'ao"��°� Lobbyist: S Verizon Name: Julie C. Smith E-Mail: Julie.c.smith@verizon.com Date Received Details 2/24/2023 New Registration - Exp. 09/2023 12/1/2023 New Registration - Exp. 09/2024 Receipt# 008796162 12/26/2023 8:55:58 AM ovoeRcoN_ Crystal K. Kinzel Clerk of the Circuit Court and Comptroller r L Customer Deputy Clerk Clerk Office Location J.SMITH BMR CASHIER Collier County Govt. Center VERIZON MinutesandRecords@CollierClerk.co Building F, 4th Floor 5055 N POINT PKWY m 3299 Tamiami Trail East, Suite ALPHARETTA, GA 30022- 239-252-2646 401 3074 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# 102 ($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. ©oaao@o@ ❑@©al Page 1 of 1