2022/2023 c
Collier County Clerk of Courts Expires Oq / "C
3299 Tamiami Trail E. (Clerk's gtfiee only)
Suite 401,Bldg. F, 4th Floor i
Naples,Florida 34112
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
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Name ( S { '� Date
Business Name 7040 r✓ ' /vim) ( (~�\
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Business Address I (0 0 (A-VI )/1
City hi q_p State r-z, Zip Code y
Business Telephone c>` 6) K 9 QContactC7 Person , T 7
Lobbyist E-mail "r l-aD G,) / c k t,J C o
Notice for Lobbyists: The annual registration fee is S25.00 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: � f
1.Name �1��^ I Cdc5
�� 2.Name (�h 7 t n
j I f ( r C
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Address 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
County of Collier
Lobby t Signature
This registration was sworn (or affirmed) and subscribed before me this j i day of,`6mU4v
20 , by ei,v2i 9
j„ Personally Known BY: > iV �,"
/ Produced ID Deputy Clerk/Notary Public
Type of ID Produced
Revised:08/2018