2016-MelissaJFox - Termination - 2016 Date Stamp
City of Long Beach
DECLARATION
Download too n
INSTRUCTIONS
1. Fill out form
2. Sign and date
. Mail to Long Beach City Clerk's office
333 W. Ocean Blvd.
Long Beach, CA 90802
Tal, 2 670-6104
C Lobbyist termination declaration for: Melissa J. Fox
(Lobbyist Name} {Filer lid number}
Covering dates from.
2/11291 to, 6/39120116
Section Filers
(ALL LOBBYISTS MUST COMPLETE SECTION ONE)
PART A. Filer Information:
Name of filer: Melissa J. Falx _
Business Address
Description of the Nature of your business or Organization. Legal
PART B. Verification of Persian Responsible for Report Preparation:
Print Name: Melissa J. Ftp
Title: Owner
Address:
Daytime Telephone N umber:
I have used all reasonable diligence in preparing this report. 1 have reviewed all the sections and to the best of my
know ledge the infarruation contained herein is true and..
City€f Lone Beach Lobbyist Registration Report Form-c[b.cc.1byteRevised ]W2012 Page I of 2
City of Long Beach
DECLARATION OF TERMINATION
Client
rDeclarations of Te inatron racist fist all efient lobbyr`nq activities that Burred between tare end cif the test semi-annual re artin ric�d and the date cif the terminaf on.ature of city
ent Name Client Address Telephone umbericial/Employe
ualrre Contacted
River Distributing Co- 1_E_
Melissa J. Fox
--
Filer 7/20116
Filer t lulrtcr etc:..
City of tong Beach Lobbyist Registration Report Form clb.cc.lbyienn Reviud 1012012 Pagc 2 Cif