Louisiana Regulations § 52-I-2137 Executive Lobbying Expenditure Report
Regulation Text
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EXECUTIVE LOBBYING EXPENDITURE REPORT
FORM 507
[] COVERING JANUARY 1- JUNE 30, _____ - DUE AUGUST 15
[] COVERING JANUARY 1 - DECEMBER 31, _____ - DUE FEBRUARY 15
OR
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________________________________
Executive Lobbyist Registration No.
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FOR OFFICE USE ONLY
Postmark Date__________
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1.
NAME _________________________________________________________________________
Last First MI
NAME CHANGE_________________________________________________________________
Last First MI
2.
BUSINESS ADDRESS _____________________________________________________________
Street and No. City State Zip
MAILING ADDRESS ______________________________________________________________
Street and No. City State Zip
3.
BUSINESS PHONE _______________________________________________________________
Area Code and Phone Number
4.
Total of all executive lobbying expenditures made January 1 through June 30: $ ________________________________________
(Include expenditures from Schedules A and B)
5.
Total of all executive lobbying expenditures made July1 through December 30: $ ________________________________________
(When Applicable) (Include expenditures from Schedules A and B)
6.
Total of all executive lobbying expenditures made during calendar year: $ ________________________________________
(Line 4 added to Line 5 should equal Line 6)
7.
Did you make an expenditure exceeding $50 on one occasion for an executive branch official:
From January 1 through June 30? [] Yes [] No
From July 1 through December 31? [] Yes [] No [] NA
If the answer to either question in Number 7 above is YES, complete Schedule A and attach.
8.
Did you make expenditures exceeding the sum of $250 for an executive branch official:
From January 1 through June 30? [] Yes [] No
From July 1 through December 31? [] Yes [] No [] NA
If the answer to either question in Number 8 above is YES, complete Schedule A and attach.
9.
Did you expend funds for any reception, social gathering, or other function to which more than twenty-five executive branch officials were invited during this reporting period?
Yes [] No []
If the answer to Number 9 above is YES, complete Schedule B and attach.
EXECUTIVE LOBBYING EXPENDITURE REPORT
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________________________________
Executive Lobbyist Registration
No.
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10.
PROVIDE BELOW
(a)
the name of the executive branch department as listed in the executive branch schedule;
(b)
the aggregate total of all expenditures attributable to the department made during the January 1 - June 30 reporting period;
(c)
the aggregate total of all expenditures attributable to the department made during the July 1 - December 31 reporting period when applicable;
(d)
the aggregate total of all expenditures made in a calendar year attributable to the department.
1)
a.
Name of Department:
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
2)
a.
Name of Department:
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
3)
a.
Name of Department:
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
11.
PROVIDE BELOW
(a)
the name of the executive branch department and the individual agency as listed in the executive branch schedule;
(b)
the aggregate total of all expenditures attributable to the agency made during the January 1 - June 30 reporting period;
(c)
the aggregate total of all expenditures attributable to the agency made during the July 1 - December 31 reporting period when applicable;
(d)
the aggregate total of all expenditures made in a calendar year attributable to the agency.
1)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
2)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
3)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $
c.
Total of all expenditures made July 1 through December 31: $
(When applicable)
d.
Total of all expenditures made during the calendar year: $
I hereby certify that the information contained herein is true and correct to the best of my knowledge, information, and belief; that all reportable expenditures have been included herein; and that no information required by LSA-
R.S.
49:71
et seq. has been deliberately omitted.
_________________________________
Signature of Lobbyist
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SCHEDULE A: EXPENDITURES FOR EXECUTIVE BRANCH OFFICIALS
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This schedule must be completed if you answered YES to either question 7 or 8 on the Executive Lobbying Expenditure Report. If, during the period January 1 through June 30 or the period July 1 through December 31, you made either a) an expenditure for any executive branch official exceeding $50 on any one occasion or b) aggregate expenditures exceeding $250 for any one executive branch official during a reporting period, then you must provide the aggregate total of expenditures made on that individual in that reporting period.
NOTE: Report covering July - December is cumulative. You must include reportable expenditures from the first half of the year in Column #3.
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1. EXECUTIVE OFFICIAL'S NAME
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2. OFFICIAL'S AGENCY AS LISTED IN THE EXECUTIVE BRANCH SCHEDULE
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3. AMOUNT OF EXPENDITURES MADE ON AN OFFICIAL FOR WHOM YOU EITHER SPENT OVER $50 ON ONE OCCASION OR MADE EXPENDITURES EXCEEDING $250 BETWEEN JANUARY 1 AND JUNE 30
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4. AMOUNT OF EXPENDITURES MADE ON AN OFFICIAL FOR WHOM YOU EITHER SPENT OVER $50 ON ONE OCCASION OR MADE EXPENDITURES EXCEEDING $250 BETWEEN JULY 1 AND DECEMBER 31
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5. TOTAL OF COLUMNS 3 AND 4
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SCHEDULE B: EXPENDITURES FOR RECEPTIONS, ETC.
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This Schedule must be completed if you answered YES to question 9 on the Executive Lobbying Expenditure Report. The following information must be provided for all receptions, social gatherings, or other functions to which
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1. NAME(S) OF GROUP(S) INVITED
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2. DATE OF RECEPTION
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3. LOCATION OF RECEPTION
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4. TOTAL AMOUNT OF EXPENDITURES
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EXECUTIVE LOBBYING EXPENDITURE REPORT
ATTACHMENT
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________________________________
Executive Lobbyist Registration No.
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· Please make as many copies as necessary to complete Item #11 of your executive lobbying expenditure report.
· Fill in your executive lobbyist registration number in the space provided in the upper right hand corner of the page.
· Identify each page with a page number and indicate the total number of pages being submitted.
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1)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $___________
c.
Total of all expenditures made July 1 through December 31: $ ____________
(When applicable)
d.
Total of all expenditures made during the calendar year: $_______________
2)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $_________
c.
Total of all expenditures made July 1 through December 31: $________________
(When applicable)
d.
Total of all expenditures made during the calendar year: $________________
3)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $_________
c.
Total of all expenditures made July 1 through December 31: $______________
(When applicable)
d.
Total of all expenditures made during the calendar year: $___________
4)
a.
Name of Department and Individual Agency:
____________________________
b.
Total of all expenditures made January 1 through June 30: $_____________
c.
Total of all expenditures made July 1 through December 31: $ ___________
(When applicable)
d.
Totalof all expenditures made during the calendar year: $ __________
History
Promulgated by the Department of Civil Service, Board of Ethics, LR 31:1243 (June 2005).
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