Lobbyist_2018_R_Ken Spiker and Associates, Inc_013118 R E _=ir' Tte StatrAb
City of Long Beach
LOBBYIST RENEWAL FORM
18 FEB
-53 A14 I
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
Filer ID Number 1
Calendar Year Covered T3
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual
fee of one hundred and seven dollars($107.00).The applicable fee is due at the time of registration renewal.
Payment will be deemed delinquent thereafter.A fine of twenty-seven dollars and forty-five cents($27.45)
per day for delinquent fees,up to a maximum of five hundred dollars($500.00),will be assessed.
Annual Registration Fee is$107.00
Late Fee Total(if applicable)$
Total submitted$ I D7
Payment Method: Cash Check
Verification of Person Responsible for Report Preparation:
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 herein is true and complete.
I certify under penalty of perjury under the laws of the
City of Long Beach Lobbyist Renewal Report Form—11/7/2017 Page 1 of 1