2012-rAbcAdvocacy Date Stamp
City of Long Beach
LOBBYIST RENEWAL FORM
INSTRUCTIONS
1. Fill out form
2. Sign and date
3. Fila with the City Clerk b2 due date with payment enclosed, along with any applicable late
fees.
Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90302
Tel. 562 570-6101
This is the Renewal Registration Report due tgayat
y 15 for:
Lobbyist Name AR AdVkAc L
Filer iC Number I0 — N
Calendar Year Covered AOMI
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual
fee of one hundred dollars(5100.00). The applicable fee is dace at the time of registration renewal.Payment
will be deemed delinquent thereafter. A One of twenty-rive dollars($25.00) per day for delinquent fees, up
j to a maximum of five hundred dollars($500.00),will be assessed,
Annual Registration Fee is$100.00
Late Fee Total(if applicable)$ lob ."
i
Total submitted S�
Payment Method: Cash Check
Verification of Person Responsible for Report Preparation:
Print Name: 10CA M
Title:
Address: '
Daytime Telephone Number:
I have used all reasonable diligence in preparing this report. I have reviewed all the sections and to the best of my
knowledge the information contained herein is true and complete.
I certify under penalty of perjury under the laws of Vie State of California that the foregoing is true and correct.
Date: Q Qj Signature.
City of Long Beaeh Lobbyist Renewal Report Form—32123(2016 Page I of I