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2017/2018 Clerk to the Board, Minutes&Records Dept. Expires 01 2o1 3299 Tamiami Trail East, Suite#401 (Staff use only) Building F,4th Floor Naples, FL 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name�( ,mac =�' . -e / • 6t /lo Date Q1 i(D I Business Address 1495 Smith Preserve Way Naples FL 34102 Business Telephone tRF3_, 6'• O'14"1/ E-Mail 674-77‘, 1, 01 -(F'"/fl 'y' 0 7. , NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1). Conservancy of Southwest Florida 1495 Smith Preserve Way Naples FL 34102 2). (PLEASE ATTACH ADDITIONAL SHEETS,IF NECESSARY) Q.C...57 C # '11 sell Lobbyist Signa ire State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this 114 day of ID ikl 20 Ik ,by &JGdt.. o �4o , who is personally known to me or has produced as identification and who didtakeanai ion,PY P4,-,, ANDREA FUCHS ` ' F: Notary Public-State of Florida ' 1 a Commission p GG 236125 BY:_�' ` 0. /` My Comm.Expires Jul IS,2022 Bonded through National Notary Assn. 0 Deputy Clerk/Notary Public The annual registration fee is $25.00 per Lobbyist,according to Collier County Ordinance No.2003-53,as amended by Ordinance 2004-05,Ordinance 2007-24 and Ordinance 2013-39. Please make payment to: Collier County Clerk of Courts or Dwight E.Brock,Clerk of Courts and mail to the address listed at the top of the form. Receipt# 007955532 7/26/2018 9:49:30 AM Crystal K. Kinzel Interim Clerk of the Circuit Court and Comptroller 2). &s. C '/C9 Egif . Customer Deputy Clerk Clerk Office Location GLADYS DELGADILLO BMR CASHIER Collier County Govt. Center CONSERVANCY OF MinutesandRecords@CollierClerk.co Building F, 4th Floor SOUTHWEST FLORIDA m 3299 Tamiami Trail East, Suite 1495 SMITH PRESERVE WAY 239-252-2646 401 NAPLES , FL 34102 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# 19948 ($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. © 000®T0g 0@CD1L Page 1 of 1