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Louisiana Regulations § 52-I-2131 Executive Lobbying Registration/Renewal

⤴ Up to Chapter 21: Executive Branch Lobbyist Disclosure Act

Regulation Text

EXECUTIVE LOBBYING REGISTRATION/ RENEWAL FOR
THE YEAR OF ______________
(Fill in year.)
________________________________
Executive Lobbyist Registration No.
FOR OFFICE USE ONLY
Postmark Date:__________
Instructions
. 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 , or fax to (225) 763-8787. For information or assistance, call (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. FAX NUMBER___________________________________________________________________
4. BUSINESS ADDRESS _____________________________________________________________
Street and No. City State Zip
MAILING ADDRESS ______________________________________________________________
Street and No. City State Zip
5. EMPLOYER _____________________________________________________________________
6. EMPLOYER'S ADDRESS ___________________________________________________________
Street and No. City State Zip
7. LIST BELOW (a) Names of persons, groups, or organizations which you represent and on whose behalf expenditures are made; (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, who pays you?___________________________________________________________
EXECUTIVE LOBBYING REGISTRATION FORM
______________________________
Executive Lobbyist Registration No .
2. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you?______________________________________________________
If No, who pays you? __________________________________________________________
3. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ___________
If No, who pays you? __________________________________________________________
4. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ___________
If No, 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 LSA- R.S. 49:71 et seq. has been deliberately omitted.
____________________________ Signature of Lobbyist
ATTACH
2" x 2"
PHOTOGRAPH
HERE
EXECUTIVE LOBBYING REGISTRATION/RENEWAL ATTACHMENT FORM
________________________________
Executive Lobbyist Registration No.
Instructions:
· Please make as many copies of this form as necessary in order to complete Question 7 of the Executive Lobbying Registration/Renewal Form.
· Fill in your Executive Lobbyist Registration No. in the space provided in the upper right hand corner of the page.
· Please identify each page with a page number and indicate the total number of pages being submitted.
1. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ______________________________________________________
If No, who pays you? __________________________________________________________
2. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ______________________________________________________
If No, who pays you?___________________________________________________________
3. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ______________________________________________________
If No, who pays you? __________________________________________________________
4. Name ______________________________________________________________________
Address ____________________________________________________________________
Business or purpose ___________________________________________________________
Does this person pay you? ______________________________________________________
If No, who pays you? __________________________________________________________

History

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2689 (December 2004), repromulgated LR 31:1236 (June 2005).

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