Form Lm-20 - Agreement & Activities Report - 2016
ADVERTISEMENT
1
2Office of Labor-Management Standards
LM-20 – AGREEMENT
U.S. Department of Labor
& ACTIVITIES REPORT
For Official Use Only
OMB No. 1245-0003. Expires XX-XX-XXXX.
E
IMPORTANT: This report is mandatory under P.L. 86-257, as amended. Failure to comply
may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or
440. Required of persons, including Labor Relations Consultants and Other Individuals
and Organizations, under Section 203(b) of the Labor-Management Reporting and
Disclosure Act of 1959, as amended (LMRDA).
Read the instructions carefully before completing this report.
1.b. Hardship Exemption
1.c. Amended Report
1.a. File Number: C-
2. Contact information for person filing:
3. Other address where records necessary to verify this report are kept:
Organization _____________________________________________
Name ___________________________________________________
Street ___________________________________________________
Title ____________________________________________________
City __________________________________________ State _____
Organization ______________________________________________
ZIP Code ______ Email Address _____________________________
Street ___________________________________________________
Employer Identification Number (EIN) __________________________
City _____________________________________________________
Contact Name ____________________________________________
State _____________________ ZIP Code _____________________
Title ____________________________________________________
Email Address ____________________________________________
5. Type of person
4. Fiscal Year Covered: from ______________through ______________
(mm/dd/yyyy)
(mm/dd/yyyy)
a. Individual
b. Partnership
c. Corporation
d. Other
6. Full name and address of employer with whom agreement or
7. Date agreement or arrangement entered into:_____________________
arrangement was made:
mm/dd/yyyy
Check this box if you are filing a report for a union avoidance seminar.
8. Person(s) through whom agreement or arrangement made:
Organization (including trade name, if any) ______________________
(a) Employer Representative:
Street ___________________________________________________
Name and Title ____________________________________________
OR
City __________________________________________ State _____
ZIP Code ______ Email Address _____________________________
(b) Prime Consultant: _______________________________________
Name and Title ___________________________________________
Employer Identification Number (EIN) __________________________
Contact Name ____________________________________________
Employer Identification Number (EIN) __________________________
Title ____________________________________________________
Address _________________________________________________
Signatures
Each of the undersigned declares, under penalty of perjury and other applicable penalties of law, that all of the information submitted in this report (including
the information contained in any accompanying documents) has been examined by the signatory and is, to the best of the undersigned’s knowledge and
belief, true, correct, and complete. (See Section VII on penalties in the instructions.)
14. Signed __________________________________________________
13. Signed _________________________________________________
Treasurer (If other title, see instructions.)
President (If other title, see instructions.)
On __________________________
__________________________
On ___________________________
__________________________
Date
Telephone Number
Date
Telephone Number
(mm/dd/yyyy)
(mm/dd/yyyy)
Form LM-20 (2016)
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal