DIANE RIPLEY 2013 RENEWAL Date Stamp
City of Long Beach I
LOBBYIST RENEWAL FORM f I >>
13 JAN 1 R W�aap�or
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
TWOS the Renewal Registration Report due January 15 for:
Lobbyist Name: (% -
Filer ID Number:
Renewal for Calendar Year: a)
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.
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➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable)
➢ Total submitted r{' ,)o
Payment Method: n Cash R'.-, Check No: �
Verification of Person Responsible for Report Preparation:
Print Name: 3 ' 101i L/l
Title: Z71�J(
Address: ���
Daytime Telephone
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
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