CARL KEMP 2013 RENEWAL Date Stamp
City of Long Beach
LOBBYIST RENEWAL FORM
Dovunload Form
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 90802
Tel. 562 570-6101
O This is the Renewal Registration Report due January 15 for:
Lobbyist Name: L'=4 rZ"Lkf�:-\E7 V'-A
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FilerID Number: ----------------------------------------------------------
Renewal for Calendar Year: ____ _________
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 day basis in accordance with Long
Beach Municipal Code 2.80,and the most recent Fee Schedule approved by Long Beach City Council.
http://www.longbeach.2ov/finance/fees and charges/
➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable) $ -0
➢ Total submitted $ 3 ' 61
Payment Method: ❑ Cash Check No:
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Verification of Person Responsible for Report Preparation:
Print Name: (�—A 2 L__ n` �C P
Title:
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