Lobbyist_2012-rKenSpiker Date Stamp
City of Long Beach
ry
LOBBYIST RENEWAL FORMTA E
C
Cd
1,2 jAV 26
INSTRUCTIONS
1. Fill out form
2. Sign and date
' 3. File with the City Clerk by due date with payment enclosed, along with any applicable late
' fees.
i
Long Beach City Clerk's Office
333W. Ocean Blvd.
Long Beach, CA 90802 i
Tel. 562 570-6101 [
E
This is the Renewal Registration Report due January 15 for:
Lobbyist Name ll&�A �
a
Filer ID Numbers
1
Calendar Year Coverelc
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual F
j fee of one hundred dollars($100.00).The applicable fee is due at the time of registration renewal.Payment
I will be deemed delinquent thereafter.A fine of twenty-five dollars($25.00)per day for delinquent fees,up
i
j to a maximum of five hundred dollars($500.00),will be assessed.
i
Annual Registration Fee is 5100.00
Late Fee Total(if applicable)5_
Total submitted$ 1(0Cs
i
Payment Method: Cash Chec&a_5
Verification of Person Responsible for Report Preparation:
4
Print�NamK )�}t��e
Title: le,6
Address:
I have used all reasonable diligence in preparing this report. 1 have reviewed all the sections and to the best of my ;
F
knowledge the information contained herein is true and complete.
I certify under penalty of perjury under the laws of the St
f
City of Long Beach Lobbyist Renewal Report Form—12/23/2010 Page I of 1
r
f
f