2013-rCalifCapitolSolutions Y � 'y V(!tV VWltlrl
-�" City of Long Beach
LOBBYIST RENEWAL FORM
13 JAtI p!�vnl p
INSTRUCTIONS
1. Fill out form
2. Sign and date
3. File with: Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90002
Tel. 562 570-6101
U This is the Renewal Registration Report due January 15 for:
Lobbyist Name: Max Del Real
Filer ID Number: CLB12-021
Renewal for Calendar Year: 2013
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.Late Fees will be assessed on a per clay basis in accordance with Long
Beach Municipal Code 2.80,and the most recent Fee Schedule approved by Long Beach City Council.
'pal Vh :r f ���l
➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable)
➢ Total submitted $ 100.00
Payment Method: ❑ Cash Q Check No:
Verification of Person Responsible for Report Preparation:
Print Name: Max Del Real
Title: CEO
Address:
I have used all reasonable diligence in preparing this report. I have reviewed all the e-cti ns and to the best of my
knowledge the information contained herein is true and