2015-rPearStrategies Date Stamp
City of Long Beach
LOBBYIST RENEWAL FORM
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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: q ✓rte
Filer ID Number:
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.longbeach.liov/finance/fees and charges/
Annual Registration Fee: $ 100.00
Late Fee Total(if applicable) $
➢ Total submitted $
Payment Method: n Cash Check No: $ 26 ¢�
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Verification of Person Responsible for Report Preparation:
Print Name: e V1 V 7a �-✓
Title: uv Vv
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 the State of true and correct.
Date: / / ' �'l Sr Signature:
City of Long Beach Lobbyist Renewal Report Form—10/2012 Page 1 of 1