LOBBYIST_2018_T_Gwen Butterfield CITY } ba*w Rair-P
City of Long Beach LONP CA
DECLARATION OF TERMINATION 18 JAN 17 M 10: 49
wwwosit ForM
INSTRUCTIONS
:j 1. Fill out form
2. Sign and date
3. Mail to: Long Beach City Clerk's Office
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333 W: Ocean Blvd:
Ong Beach CA 00$02
w.� Beach, vr. v v
Tel. (562)570-6101
O Lobbyist termination declaration for:
(Lobbyist Name) (Filer ID number)
v0'verii7g dales from: 7-111I to: ltd 1
Section 1- Information About All Filers
(ALL LOBBYISTS MUST COMPLETE SECTION ONE)
PAR1 A. Eller I11formatlon:
Name of Filer: ,e(d
Business Address: �
Business Fax Number:
Description of the Nature of your Business or Organization:
PART B. Verification of Person Responsible for Report A
p e ort Pre araHon:
Print Name: .)
Title.
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 d herein is true
Date: c
. Ig"w" ui c.
i
..7 Beeach Lohbyrsl Reesas.luuorl Reeport Form.-clb.cc.11 leer...Retnsed 10/2012
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City of Long Beach
DECLARATION OF TERMINATION
Section 2 - (Tient Termination Information
All Declarations of Termination must list all client lobbying activities that occurred peAveen the end of the last semi-annual reporting period and the date of the te,rrnihation.)
Client Name Client Address TelephonNature of City
e Number Official/Employee
Business
Contacted
Filer name: �� _ Filer ID Number 11— Date 1 c7 I
City of Long Beach Lobbyist Registration Report Form—clb.cc.lbyterm Revised 10/2012 Page 2 of 2