Skip to main content

Louisiana Regulations § 52-I-1907 Lobbying Registration Form

⤴ Up to Chapter 19: Legislative Branch Lobbyist Disclosure Act

Regulation Text

LOBBYING REGISTRATION FORM
To be used for initial registrations and renewals
_____________________
Lobbyist's Registration Number
FOR OFFICE USE ONLY
Postmark Date:______
· Print in ink or type.
· Complete form and return with $110 registration fee to the Board of Ethics,2415 Quail Dr. , 3rd Floor, Baton Rouge , LA 70808 , (225) 763-8777 or (800) 842-6630.
· Initial registrations must be submitted within 5 days of (1) employment as a lobbyist or (2) first action requiring registration. Registrations expire as of December 31 unless a renewal is submitted between December 1 and January 31 .
1. NAME_____________________________________________________
Last First MI
2. BUSINESS PHONE___________________________________________
Area Code and Phone Number
3. BUSINESS ADDRESS____________________________________________________________
Street and No. City State Zip
MAILING ADDRESS_____________________________________________________________
Street and No. City State Zip
4. EMPLOYER____________________________________________________
5. EMPLOYER'S ADDRESS___________________________________________________________
Street and No. City State Zip
6. LIST BELOW (a) Names of persons, groups, or organizations which you represent; (b) the address of each such person, group, or organization you represent; (c) the type of business each is engaged in or the purpose or function of the organization or group; (d) whether or not the client or someone else pays you to lobby.
1. Name_________________________________________________________
Address_______________________________________________________
Business or purpose______________________________________________
Does this person pay you? _____
If No, then who pays you?_________________________________________
2. Name_________________________________________________________
Address_______________________________________________________
Business or purpose______________________________________________
Does this person pay you? _____
If No, then who pays you?_________________________________________
3. Name_________________________________________________________
Address_______________________________________________________
Business or purpose______________________________________________
Does this person pay you? _____
If No, then who pays you?_________________________________________
4. Name_________________________________________________________
Address_______________________________________________________
Business or purpose______________________________________________
Does this person pay you? _____
If No, then who pays you?_________________________________________
CERTIFICATION OF ACCURACY
I hereby certify that the information contained herein is true and correct to the best of my knowledge, information, and belief; and that no information required by the Lobbyist Disclosure Act [LSA- R.S. 24:50 et seq.] has been deliberately omitted.
_________________________________________
Signature of Lobbyist
ATTACH
2" x 2"
PHOTOGRAPH
HERE

History

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2680 (December 2004), repromulgated LR 31:627 (March 2005).

Explore Related Documents

This section contains links to related documents with the same tags to allow you quickly access other relevant legal materials. These links include document types and counts, enabling you to explore similar content efficiently.