2019/2020Collier County Clerk of Courts
3299 Tamiami Trail E.
Suite 401, Bldg. F, 4"' Floor
Naples, Florida 34112
Expires
(Clerk's office only)
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name f-C%?-� lL X F-�� Date
Business Name LD M (9-- $dyi LO 6Ry
Business Address M-5 A tq6wd u J'4 Po t P D lZ / V (2--
City
NheteS
State r L—
Zip Code .3 4YI 46
Business Telephone (2,3q-2.19' 20 7() Contact Person 6-ArM °-if `
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:
tJ I
1. Name t 1 IZ IS-ZJ �% �' N (° m TQ i7 i �2 rN�ame
3 rJs T y►4 rl
Address I IZ el St%Z C LC..4 N' S "yAddress
City/State N H fL`e-S , 15 Zip // City/State
3. Name %nAwoL-/ A -Pd&�D 1•.LC4. Name
Address '3 (l � M +GW t Li/ A" �P&O--A P 2
Address
City/State N A Pt-Lv-<-' � FL- Zip 3411 6 City/State
(ATTACH ADDITIONAL CLIENT SHEETS, IF NECESSARY)
State of Florida
County of Collier
Zip
Zip
Lobb st Signature
Thisregistration was sworn (or affirmed) and subscribed before me this :. day of,
20 by
Personally Known BY:
Produced ID Deputy Clerk/Notary Public
Type of ID Produced I
Revised: 08/2019
Receipt# 008166614
1 /21/2020 11:30:04 AM
VAC01" Crystal K. Kinzel
.� Clerk of the Circuit Court and Comptroller
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O�o
TF. CIR�J
Customer Deputy Clerk Clerk Office Location
GARRETT FX BEYRENT BMR CASHIER Collier County Govt. Center
LONGBOAT LOBBY MinutesandRecords@CollierClerk.co Building F, 4th Floor
3115 MAGNOLIA POND DR m 3299 Tamiami Trail East, Suite
NAPLES, FL 34116-8308 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
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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