LOBBYIST_2017_T_Jimmy Blackman i
City of Long Beach l
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DECLARATION OF TERMINATION
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INSTRUCTIONS 17 JAN 17 PM 4: 4 .
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: Jimmy Blackman / CLB 15 031
(Lobbyist Name) (Filer ID number)
1/11/20117 12/31/2017
Covering dates from: to:
Section 1- Information About All Filers
(ALL LOBBYISTS MUST COMPLETE SECTION ONE)
PART A. Filer Information:
Name of Filer:
Jimmy Blackman
Business Address:
Business Fax Number:
Description of the Nature of your Business or Organization: OV2rnment& PUbIIC Affairs OnSUItSnt
PART B. Verification of Person Responsible for Report p p t Preparation:
Print Name:
Title:
Address:
Daytime Telephone Number:
I have used all reasonable diligence in preparing
I
i
City of Long Beach
DECLARATION OF TERMINATION
Section 2 - Client Termination Information
All Declarations of Termination must list all client lobb n activities that occurred between the end of the last semi-annual re orNn edod and the date of the te_rminaSon.)
Nature of City
Client Name Client Address Telephone Number Official/Employee
Business Contacted
B FF Local 372
PACE program ione
Jimmy Blackman CLB-15-031 1/17/2017
Filer name: Filer ID Number Date
City of Long Beach Lobbyist Registration Report Form—clb.cc.lbyterm Revised 10/2012. Page 2 of 2