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2018/2019 Collier County Clerk of Courts Expires 061 wig 3299 Tamiami Trail E. (Clerk's o fice only) Suite 401, Bldg. F, 4t1 Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name /111141- t- 9'9A C Zy)- Date - [q Business Name fT O--Mc 1 - L A v" 4-K Business Address 6W3b 6 (i- Pr Z© I City Al 1 -±-� State a, Zip Code 3'fl o Business Telephone?34—6,3(-((q Contact Person CP Lobbyist E-mail /11/(k e 1A✓I^G l y(4vJt'Irv\. Notice for Lobbyists: The annual registration fee is $25.00 her 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 T t0476446 cb\ 2. Name ` �pr^'lA Address - ( Address City triVa S Zip Code J"l i d' City Zip Code 3. Name 4. Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida C/J County of Collier 1 L Lobbyist Signature f'.a This registration w s sworn(or affirmed) and subscribed before . e "� • dayC of, \t , , 20 n , by � YAC'Z" � � fat Personally Known Produced ID Deputy Clerk/Nota Publi, Type of ID Produced Revised:08/2018 Lobbyist Registration Quarterly Update GLAVO (\.( D-Vic&A 7/9/2019 10:56:47 AM Crystal K. Kinzel Clerk of the Circuit Court and Comptroller o fff@ - �� @(c) o ER Customer Deputy Clerk Clerk Office Location MARK ADAMCZYK BMR CASHIER Collier County Govt. Center ADAMCZYK LAW FIRM, PLLC MinutesandRecords@CollierClerk.co Building F, 4th Floor 9130 GALLERIA CT STE 201 m 3299 Tamiami Trail East, Suite NAPLES, FL 34109-4381 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 Check# 1397 ($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. ©QQQ11QI(@QQ[ ❑ggal Page 1 of 1