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2009/2010 Board Minutes & Records 3301 Tamiami Trail East Building F, 4th Floor Naples, FL 34112 Expires: 2010-09-18 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Name: Vipul Grover Date: 2009-09-18 Business Address: 979 N. Collier Blvd. Marco Island. FI 34145 Business Telephone: + 1 (239) 963-2344 Email: vgrover@vipinsservices.com NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED: 1. Marco Island Chamber of Commerce, 1102 N. Collier Blvd., Marco Island, FL 34145 PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY #-' (// ('- 0_-_______ State of Florida County of Collier The foregoing registration was sworn to and subscribed before me on this \~~n day Of~~Y\~JQ21 by V.j pu"'\ C;1tb~(' , who is personally known to me or has produced as identification and who did take an oath. ~o"\"'\f' .~<r. Notary Public State of Flonda . . Lisa B Penzo ~ ,~My Commission 00812094 "', OF!\.o~ Expires 0810512012 The annual registration fee is $25.00 per Lobbyist, according to Collier county Ordinance No. 2003-53,as amended by Ordinance 2004-05 and Ordinance 2007-24. Please make payment and mail to:Collier County Clerk of Courts or Dwight E. Brock, clerk of Courts (at the address listed at the top of the form). Receipt# 007023284 10/1/20097:54:10 AM Dwight E. Brock Clerk of the Circuit Court (c2x~n'O C(5~ Fj cID D [~~ C~X~X~ 0 I~) 11 Customer VIPUL GROVER MARCO AREA CHAMBER OF COMMERCE 1102 N COLLIER BLVD MARCO ISLAND, FL 34145- 2547 Deputy Clerk BMR CASHIER M inutesand Records@CollierClerk.com 239-252-2646 Clerk Office Location Collier County Govt. Center Building F. 4th Floor 3301 Tamiami Trail East P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY 1 DESCRIPTION BMR Lobbyist Registration UNIT COST $25.00 TOTAL AMOUNT DUE: Check# 6214 BALANCE DUE: AMOUNT $25.00 $25.00 ($25.00) $0.00 t?D n/70 t?Dn n- l0@UL 0 @rr~:!Ju @{rt::{o ({;;@rtUD Page 1 of 1