DAKOTA_COMMUNICATIONS_2014-Renew Date Stamp
City of Long Beach $ °""ED
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LOBBYIST RENEWAL FORM
14 JAN I Sow o aFom
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 „ o �— C _; 1,. .s V"tC:.
Filer ID N umber:
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.lonLI)each.eov/finance/fees and charges/
➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable) $
Total submitted $
Payment Method: El Cash Check No:
Verification of Person Responsible for Report Preparation:
Print Name:
Title:
I have used all reasonable diligence in preparing this report. I have
ate: I d ignature:
City of Lon.-Beach Lobbyist Renewal Report Form—10/2012 Page 1 of 1