Form A - Lobbyist'S Annual Report
ADVERTISEMENT
1
2A
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE, Eric Clark
FORM
Lobbyist’s Annual Report
page 1 of 2
For office use only. Do not write in this
Faxed reports must be followed by originals.
space.
Please - no copies - no staples.
INSTRUCTIONS
:
How to locate forms on our website
1. Complete all information.
2. Annual Reports “A”, for Lobbyists, must be signed
Elections
by lobbyist and notarized.
Lobbying
Lobbying Forms Library
Logged in by / Date
Mississippi Secretary of State
“R” – Registration
Attn: LOBBYING
“E” – Mid Session
Physical: 401 Mississippi Street,
“E” – End-of-Session
Lobbying Year
Jackson, Mississippi 39201
“A” – Lobbyist Annual Report
Mailing:
Post Office Box 136
“C” – Client Annual Report
Begin:
Lobbying Beginning
Jackson, Mississippi 39205-0136
Follow directions for extensions
(No Earlier -Jan. 1)
(601) 359-6353 [phone] (601) 359-1499 [fax]
End:
th
(1) Lobbyists who register on or before February. 25
must file a Mid-Session “E” and End-of-Session
Lobbying Ending
th
“E”. (2) Lobbyists who register from February 26
through sine die must file an End-of-Session “E”.
st
(No Later- Dec. 31
)
(3) All Lobbyists must file an “A”, Lobbyist’s Annual Report, and all Clients must file a “C”, Lobbyist’s
th
Client Annual Report on or before January 30
for the preceding lobbying year.
Lobbyists/Clients must notify our office if there are changes of addresses or phone numbers.
Certificate No. #
Please write the name on your client exactly as it was written on your registration form. Do not
abbreviate.
General Information
th
ORIGINAL Report (report due on January 30
for the previous year’s activity)
1.
Client Certificate
2.
Cycle Year
3.
Type of Report
Number
AMENDED Report (Orig. report amended due to corrections or omissions)
TERMINATING Report (for filers terminating prior to Dec. 31 – Include “T”)
SECTION A: Identification
4.
Full name of LOBBYIST
5.
Occupation
6.
Physical Address of LOBBYIST (required)
City (or/Country)
State
Zip
7.
Mailing Address of LOBBYIST
City
State
Zip
8.
Permanent Phone (
)
9.
Fax (
)
10.
E-mail
11.
Cell Phone (
)
12. Is Client a State Agency?
Yes:______
No:_______
13.
Full Name of Lobbyist’s Client
SECTION B: Lobbyist’s Compensation
Disclose amount of compensation for each category.
14. Fee
15. Salary
16. Retainer
17. Reimbursement
18. Other
19. TOTAL
,
SECTION B
$
$
$
$
$
Description of other
$
compensation from Item 18:
Form A [rev. July-05]
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal