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2021/2022 Collier County Clerk of Courts Expires og 3299 Tamiami Trail E. (Clerk's/9.0? e only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name C(111—(.'f t 1/(A9 (� `\ Date (7 ass � I a-r Business Name t '`-C r O h Business Address 4 Q G T f e ( vi ( a ( City 1V �1.f(Qs State L Zip Code 3 yc/o cid / 0 Business Telephone g-3 1 ( 1 l ®O Contact Person c k41,s 14-0('vim ✓1 Lobbyist E-mail 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: i4 f I S 'Q 1. Name 2. Name Address 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 C/44/1;.1 tr7 County of Collier Lobbyist Signature This registration was sworn (or 9Ifirme ) and subscribed before me this4.- c1yy.of, 20�1 , by ( ,�:s ,�r� -'�1(�. s �, Personally Known BY: ' , ' 4filk Produced ID Deputy Clr o,tary 'ublic Type of ID Produced Revise. 08/ 419 Receipt# 008446094 9/10/2021 10:56:45 AM cuvvoeco<,yrti Crystal K. Kinzel Clerk of the Circuit Court and Comptroller <���OFTHF.CIR�J` , 0ff:101—O ga \ 1/4.-7 (7 ER Customer Deputy Clerk Clerk Office Location CHRIS THORNTON BMR CASHIER Collier County Govt. Center THORNTON LAW FIRM MinutesandRecords@CollierClerk.co Building F, 4th Floor 7400 TRAIL BLVD STE 121 m 3299 Tamiami Trail East, Suite NAPLES, FL 34108-2855 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 CHRISTOPHER THORNTON CAPITAL ONE: 7890 (Approval: 8339b282-f2d1-4ea8-8d59- ($25.00) be7176975680 ) BALANCE DUE $0.00 Note: 9/10/2021 10:56:45 AM BMR CASHIER: An additional card convenience fee of 3.5%was paid to nCourt LLC for a total card amount of: $25.88. Questions regarding processing fees should be directed to nCourt at(239)207-3731 or(800) 701-8560. Reference Invoice Number: 8339b282-f2d1-4ea8-8d59-be7176975680 and Item Number: 05320210910105559 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. ©01111LJQiTag@CM Page 1 of 1