2018/2019 9
Collier County Clerk of Courts Expires ( G
3299 Tamiami Trail E. (Clerk's ort ee only)
Suite 401, Bldg. F, 4th Floor
Naples, Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name Date 62(110/
Business Name `14J-it-cvi t. £ ' t 44-7 ZZA reiVA-414.71 7-X-1
Business Address "L 21z) �
Cityge 'v State FL- Zip Code
Business Telephone 'q(z--3V Contact Person /We 6464,66,47z,
Lobbyist E-mail ilkad cair('GCa-yebt't-' 641'7/z ff.-
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 and Ordinance 2007-24. Payments
made out to: Collier County Clerk of Courts or Crystal K. Kinzel, Clerk of Courts
(ADDRESS LISTED ABOVE)
NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED:
1. Name .1/44f- 2. Name
Address Address
City Zip Code City Zip Code
3. Name 4. Name
Address Address
City Zip Code City Zip Code
(ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY)
State of Florida .,
County of Collier
Lobbyist Signature P`
This registration was sworn (or affirmed) and subscribed before me this C ` 1 day of; U itt•
20 , by
Personally Known B I 411r
---Z.Produced IDp Deputy Clerk/Notary Public
-Ty"pe of ID Produced F--k Irl vI le •
Revised:08/2018
6/11/2019 9:45:56 AM
Crystal K. Kinzel
Clerk of the Circuit Court and Comptroller
o
0 fff o 0 - -JDER0
Customer Deputy Clerk Clerk Office Location
MAC CARRAWAY BMR CASHIER Collier County Govt. Center
ENVIRONMENTAL MinutesandRecords@CollierClerk.co Building F, 4th Floor
RESEARCH & EDUCATION m 3299 Tamiami Trail East, Suite
FOUNDATION 239-252-2646 401
3500 S FLORIDA AVE STE 7 P.O. Box 413044
LAKELAND, FL 33803-4869 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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