2016-rCordero&Assc (2) Date Stamp
City of Long Beach
LOBBYIST RENEWAL FORM
INSTRUCTIONS p�
1. Fill out foam
2. Sign and date
3. File with: Long Beach City Clerk's Office
333 W. Ocean Blvd.
Long Beach, CA 90802
Tel. 562 570-6101
O This is the Renewal Registration Report due January 15 for:
Lobbyist Name: brdnro +A5soC1aaf&5
Filer ID Number: 13 - 0 a a,,
Renewal for Calendar Year: a�
Registration Fees: Persons subject to the registration requirements of this ordinance shall pay an annual
fee of one hundred dollars($100.00).The applicable fee is due at the time of registration renewal. Payment
will be deemed delinquent thereafter.Late Fees will be assessed on a per day basis in accordance with Long
Beach Municipal Code 2.80,and the most recent Fee Schedule approved by Long Beach City Council.
htty://www.longbeach.eov/finance/fees and charges/
➢ Annual Registration Fee: $ 100.00
➢ Late Fee Total(if applicable) $
➢ Total submitted $ ,
Payment Method: El Cash Check No:
Verification of tPerson Responsible for Report Preparation:
Print Name: C 10 r 10i co rd ero
Title: CAIN Stl/11 fa n t
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 State of California that the foregoing is true and correct.
Date: I IdD 15- Signature:
City of Long Beach Lobbyist Renewal Report Form—10/2012 Page 1 of 1