Form E - Lobbyist'S Mid-Session/end-Of-Session Expenditure Report 2005
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1E
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE, Eric Clark
FORM
Lobbyist’s Mid-Session/End-of-Session Expenditure Report
page 1 of 1
Faxed reports must be followed by originals.
For office use only. Do not write in this
space.
Please - no copies and no staples.
INSTRUCTIONS
:
1. Complete all information.
How to locate forms on our
2. Only Lobbyists file a Mid-Session “E”, or
website
End-of-Session “E” Report.
Elections
Mississippi Secretary of State
Lobbying
Attn: LOBBYING
Logged in by / Date
Lobbying Forms Library
Physical:
“R” – Registration
401 Mississippi Street
“E” – Mid Session
Jackson, Mississippi 39201
Lobbying Year
“E” – End-of-Session
Mailing:
“A” – Lobbyist Annual Report
Post Office Box 136
Begin:
Lobbying Beginning
“C” – Client Annual Report
Jackson, Mississippi 39205-0136
(No Earlier -Jan. 1)
Follow directions for extensions
(601) 359-6353 [phone] (601) 359-1499 [fax]
th
(1) Lobbyists who register on or before February. 25
must file a Mid-Session “E” and End-of-Session
Lobbying Ending
End:
th
st
“E”. (2) Lobbyists who register from February, 26
, through sine die must file an End-of-Session
(No Later- Dec. 31
)
“E”. (3) All Lobbyists and Clients must file an Annual Report – “A” Lobbyist/ “C” Client.
Certificate No. #
Lobbyists/Clients must notify our office if there are changes of addresses or phone numbers.
SECTION A. Registration Information
1.
LOBBYIST
2.
LOBBYIST’S CLIENT (Do not abbreviate)
Mid-Session
End-of-Session
Amended Report
3.
Certificate Number
4.
Cycle Year
5.
Type of Report
th
February 26
10 days after sine die
SECTION B. Itemized Expenditures
TO COMPLETE THIS SECTION
:
1.
In the column marked “Recipient,” disclose the public official or employee receiving anything of value or other payment during the period of the
report. If someone other than the public official or employee is given or promised the thing of value on behalf of the official or employee, report
that person’s name also. DO NOT INCLUDE receptions as defined in Miss. Code Ann. §5-8-11 (7)(a) (1972).
2.
In the column “Recipient’s Office Title,” disclose the public office, position, or title the recipient holds. Disclose the “Date” and “Place” the item
was given, the “Provider,” a “Description” of the item, and its “Value/Cost.”
3.
If additional space is required for itemized expenditures, complete and attach Form XL (Itemized Legislative Expenditures).
Recipient’s
Recipient
Date
Place
Provider
Description
Value/Cost
Office Title
a.
$
b.
$
c.
$
TOTAL, this page
$
XL
Attached Form
Lobbyist’s Signature
I certify that the above information is true and correct, according to my knowledge, information, and belief.
Print name here. ________________________________Signature _____________________________________
PENALTY NOTIFICATION: Miss. Code Ann.§5-8-17(1) (1972).
Page 1 of ____
Form E [rev. Sep-05}
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