Form C - Lobbyist'S Client Annual Report
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1
2C
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE, Eric Clark
FORM
Lobbyist’s Client Annual Report
page 1 of 2
Faxed reports must be followed by originals
For office use only. Do not write in
this space.
Please – no copies and no staples
How to locate forms on our website
INSTRUCTIONS
:
1. Complete all information.
Elections
2. Annual Reports “C”, for Clients, must be signed
Lobbying
Lobbying Forms Library
by Client and notarized.
“R” – Registration
“E” – Mid Session
Mississippi Secretary of State
“E” – End-of-Session
Attn: LOBBYING
Logged in by / Date
“A” – Lobbyist Annual Report
Physical: 401 Mississippi Street,
Jackson, Mississippi 39201
“C” – Client Annual Report
Follow directions for extensions
Mailing:
Post Office Box 136
Lobbying Year
Jackson, Mississippi 39205-0136
(601) 359-6353 [phone] (601) 359-1499 [fax]
Begin:
Lobbying Beginning
(No Earlier -Jan. 1)
th
(1) Lobbyists who register on or before February. 25
must file a Mid-Session “E” and End-of-Session “E”.
th
(2) Lobbyists who register from February 26
through sine die must file an End-of-Session “E”. (3) All
Lobbying Ending
End:
Lobbyists must file an “A”, Lobbyist’s Annual Report, and all Clients must file a “C”, Lobbyist’s Client Annual
st
(No Later- Dec. 31
)
th
Report on, or before, January 30
for the preceding lobbying year.
Certificate No. # (s)
Clients must notify our office if there are changes of addresses or phone numbers.
SECTION A: Identification
1. Lobbyist’s Client ( Full Name)
2. Physical Address (required)
City (or Country)
State
Zip
3. Mailing Address
City (or Country)
State
Zip
4. Permanent Phone #
Fax #
E-mail
5. Cycle Year
6. Type of Report
TERMINATING Report
ORIGINAL Annual
AMENDED Annual Report
(ending activity prior to
Report (report due
(report returned to you for
th
December 31)
January 30
for the
correction)
previous year’s activity)
SECTION B: Administrative Operation Costs
7. List below the names of all LOBBYISTS registered by you during this
8.
Total compensation for all Lobbyists
$
calendar year and total compensation for each lobbyist. If activity
as identified in Item 7-B.
terminated before December 31, indicate the termination date.
$
9.
Reimbursement(s) to Lobbyists
Lobbyist Name
Certificate No.
Early Term. Date
Compensation
$
$
10.
Overhead
$
$
11.
Direct Payments
$
$
12.
Lobbying Expenses
$
13.
Urging others to communicate
$
(advertising, direct mail, etc.)
$
$
TOTAL
14.
(8-13)
$
7-B Total
$
Form C [rev. July-05]
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