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2019/2020 Collier County Clerk of Courts Expires 6g I 3299 Tamiami Trail E. (Clerk's of ice only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name .,J CNN l fErB OOT Date /0 V Business Name (....r.spcp Business Address r City / � � State % (� Zip Code J c ae5/ Business Tel ?o e Li YS- 5 Contact Person 1 Lobbyist E-mail hD1036oai(0 , c_eq . Oro 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. NameP 2. Name Address ("a . ) 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 111, County of Collier Lobbyist :ig re /- This registratioqwas sworn (or a firmed) and subscribed before me this rk day of, C}± , 20 0, by e,InY.;R tilocA Personally Known BY: 1 fir Produced ID Deputy Clerk/Notary Publi Type of ID Produced ST-4_,V___,2 Revised:08/2018 Receipt# 008125784 10/8/2019 9:07:31 AM Gcp,ER�o�NTr Crystal K. Kinzel Clerk of the Circuit Court and Comptroller 4TE ` `J`�LO . O Customer Deputy Clerk Clerk Office Location JENNIFER HOBGOOD BMR CASHIER Collier County Govt. Center ASPCA MinutesandRecords@CollierClerk.co Building F, 4th Floor 2105 CHEEKE NENE m 3299 Tamiami Trail East, Suite TALLAHASSEE, FL 32301- 239-252-2646 401 6763 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 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. ©®11011®IT@UWg0Ela Page 1 of 1