2013-rPoliticalConsultingMgnt Date Stamp
City of Long each
LOBBYIST RENEWAL FORMA
Download 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
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This is the Renewal Registration Report due J' nu Or: -A
Lobbyist Name: David Carlat
Filer ID Number: CLB12-019
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.
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➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable) $
➢ Total submitted $
100.00
Payment Method: El Cash 6 Check No:
Verification of Person Responsible for Report Preparation:
Print Name: David Carlat
Title: President
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
City of Long Beach Lobbyist Renewal Report Form—10/2012 Page 1 of 1