2017-rDougOtto Date Stamp
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City of Long Beach
LOBBYIST RENEWAL FORM a '
11 AIN 13 Ph T 31
INSTRUCTIONS
1. Fill out form
2. Sign and date
3. File with the City Clerk by due date with payment enclosed, along with any applicable late
fees.
Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90802
Tel. 562 570-6101
This is the Renewal Registration Report due January 15 for:
Lobbyist Name Douglas W. Otto
Filer ID Number CLB15-030
Calendar Year Covered 2017
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual
fee of one hundred and five dollars($105.00).The applicable feels due at the time of registration renewal.
Payment will be deemed delinquent thereafter.A fine of twenty-five dollars ($26.85)per day for
delinquent fees,up to a maximum of five hundred dollars ($500.00),will be assessed.
Annual Registration Fee is$105.00
Late Fee Total(if applicable) $
Total submitted $ 105
Payment Method: Cash Check #4055
Verification of Person Responsible for Report Preparation:
Print Name: Douglas W. Otto
Title: Owner
Address:
I have used all reasonable diligence in preparing this report.
Date: 1/13/2017 Signature:
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City of Long Beach Lobbyist Renewal Report Form—9/6/2016 Page 1 of 1
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