Lobbyist_2013-rKenSpiker Date Stamp
'� . City of Long each r;5
LOBBYIST RENEWAL FORM
1 14 P �R!rand 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. 662 570-6101
O
This is the Renewal Registration Report due January '5 for:
Lobbyist Name: e y c 'fe
Filer I® Number: 00�
Renewal for Calendar Year: d
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.
and .a11 1-
Annual Registration Fee: $ 100.00
Late Fee Total(if applicable)
A Total submitted $ 00 1 O D
Payment Method: Cash n Check No:
Verification of Person Responsible for Report Preparation:
Print Name: K SP i �
Title: CC-0
Daytime Telephone Number:
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
Date: < <� Signature:
City of Long Beach Lobbyist Renewal Report Form-10/2012 Page 1 of 1