2015-rGwenButterfield City of Long Beach
LOBBYIST RENEWAL FORM
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INSTRUCTIONS � � A � ; 5
1. Fill out form
2.. Sign and date
3. File with: hong Beach City Clerk's Office .
333 W. Oc,can Blvd.
Long Beach, CA 10802
Tel. 562 570-6101
O This is the Renewal Registration Report due January 15 for:
Lobbyist Name: Gwen Butterfield
Filer ID Number: 11-011
Renewal for Calendar Year:, 2015
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 Fec Schedule approved by Long Beach City Council.
http://�vtivov<longbeach oNT/finance/fees and chargesy
➢ Annual Registration Fee: 100.00
➢ Late Fee Total(if applicable) $
➢ Total submitted $ 100.00
' Payment Method: Cash M Check No: I�9
Verification of Person Responsible for Report Preparation:
Print Name: Lacey Adams
Title:
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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