Lobbyist_2019_T_Stefan Borst-Censullo (Formerly Grass Roots Government Services)_01012019 Updated 1/1/2019 LOBBYIST REGISTRATION&REPORTING FORM
City Clerk of Long Beach
LOBBYIST REGISTRATION & REPORTING FORM
Page 2 of 3
SECTION 11
❑ I certify that I have been authorized by the Lobbyist identified above to make this verification. I have reviewed the requirements of the
f provision of the Long Beach Municipal Code(LBft1C Chapter 2.CH- obb+fists). I certify under penalty of perjury under the laws of the
State of California that I have reviewed this Termination and to the best of my knowledge the information contained herein is true and
complete.
Print Name:Stefan Borst-CensulloTitle:owner
Signature: Date: 112812021
EMEMEM
SELECT ALL THAT ARE APPLICABLE
Roaistration Registration Reduced Fee Reaistration Fee for Additional Reaistration Late
Fee$115 t Year $58 t Year Clients$28 t Client Fee$29.051 Day
Total 0
Lobbyists Fees are subject to change on a quarterly basis. Please see the Current Fee Schedule to apply the correct fees.
MAKE CHECKS PAYABLE TO:
CITY OF LONG BEACH
FORMS AND PAYMENT CAN BE SENT TO:
CITY OF LONG BEACH -C/O OFFICE OF THE CITY CLERK
411 WEST OCEAN BLVD. LONG BEACH,CA 90802
NOTE: Late fees will apply to any lobbying activity not reported after the 15 days of qualifying as a lobbyist
I have reviewed the lobbyist guidelines and I have nothing to report. I have indicated as such in SECTION III for this period.
Attached to this report is SECTION III, which lists the current activity for this period.
MEMEMM
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.
PrintName:Stefan Borst-Censullo Title:owner
Signature: Date: 1/2812021
Updated 111!2019 LOBBYIST REGISTRATION&REPORTING FORM