THE_CHERIN_GROUP_2016-Termination TY CL�El;�stamp
City of Long Beach LONG 13FACH, CA
DECLARATION OF TERMINATION 16 JAN 20 .PM
Download Form
INSTRUCTIONS
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: Inc ;/1 &f t--Q /AAqCk,nin / CL j-13-�dj
(Lobbyist Name) (Filer ID number)
Covering dates from: i5 to: %a► 1 3 1 115
Section I- Information About All Filers
(ALL LOBBYISTS MUST COMPLETE SECTION ONE)
PART A. Filer Information:
Name of Filer: 'The— t-y4'"v% C f AL-i
Business Address: '
Description of the Nature of your Business or Organization: CcrS "�
PART B. Verification of Person Responsible for Report Preparation:
Print Name: Nt L4 4� 1 rl�, Cyc n A �- ✓
Title: Ow v,c r
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.1 certify under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Date: 1 ` '6
Signature:
City of Long Beach Lobbyist Registration Report Form—clb.cc.lbytcnn Revised 10/2012 Page] of 2
i
City of Long Beach
DECLARATION OF TERMINATION
Section 2 - Client Termination Information
All Declarations of Termination must list all client iobbying 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
lContacted
I
Filer name: FilerIDNumber 3 Dale
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City of Long Beach Lobbyist Registration Report Form—clb.cc.lbyterm Revised 102012 Page 2 of 2