R Montgomery_2012-Renew Date Stamp
City of Long Beach
iii
LOBBYIST RENEWAL FORM 7y G; ,E K,12 JAN I I q)
PM 1+ 0.1
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.
Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90802
Tel. 562 570-6101
This is the Renewal Registration Report due January 15 for:
Lobbyist Name Richard P. Montgomery
Filer ID Number CLB11-016
Calendar Year Covered 2012
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual
fee of one hundred dollars($100.00). The applicable fee is due at the time of registration renewal.Payment
will be deemed delinquent thereafter.A fine of twenty-five dollars($25.00)per day for delinquent fees,up
to a maximum of five hundred dollars($500.00),will be assessed.
Annual Registration Fee is$100.00
Late Fee Total(if applicable)$
Total submitted$100.00
Payment Method: Cash Check YES
Verification of Person Responsible for Report Preparation:
Print Name: Richard P. Montgomery
Title:Principal
Address:
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 the State of California that the foregoing is true and correct.
Date: January 13th, 2012 Signature:
City of Long Beach Lobbyist Renewal Report Form—12123/2010 Page 1 of 1