CARL_KEMP_2014-Termination Date Stamp
City of Long Beach CR E CEI Y ED
CITY CLERK
DECLARATION OF TERMINATION L i0 p,Y _A;, ,
14 JALi ad Form
INSTRUCTIONS 17
1. Fill out form
2. Sign and date
3. Mail to: Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90802
Tel. (562) 570-6101
O Lobbyist termination declaration for:
(Lobbyist Name) (Filer ID number)
Covering dates from: � v'LY / L� -3 to: =- I Z�31 /lIs
l
Section 1- Information About All Filers
(ALL LOBBYISTS MUST COMPLETE SECTION ONE)
PART A. Filer Information:
Name of Filer: iol—
Business Address: -
-
Business E-mail Address: '
Business Phone Number: �-
Business Fax Number:
Description of the Nature of your Business or Organization: e SLf l
PART B. Verification of Person Responsible for Report Preparation:
Print Name: A tz- L-
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
Date: Signature:
City of Long Beach Lobbyist Registration Report Form—c1b.cc.1byterm Revised 10/2012 Page 1 of 2
City of Long Beach
DECLARATION OF TERMINATION
Section 2 - Client Termination Information
All Declarations of Termination must list all client lobbying activities that occurred between the end of the last semi-annual reporting eriod and the date of the termination.
Nature of city
Client Name Client Address Telephone Number Business Official/Employee
Contacted
Filer name: Filer ID Number Date
City of Long Beach Lobbyist Registration Report Form—clb.cc.lbytenn Revised 10/2012 Page 2 of 2