Form Xmc - Itemized Expenditures Benefiting Multiple Clients - Extension For "A" Or "E" - 2005

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XMC
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE, Eric Clark
FORM
Itemized Expenditures Benefiting Multiple Clients – Extension for “A” or “E”
For office use only. Do not write in this
Faxed reports must be followed by originals.
space.
Please - no copies and no staples.
INSTRUCTIONS
:
1. Complete all information.
How to locate forms on our website
2. “XMC” can be used to benefit multiple Clients.
Elections
3. “XMC” can be used as an extension to the Mid-
Lobbying
Session “E”, the End-of-Session “E”, or the
Lobbying Forms Library
Lobbyist’s Annual Report “A”.
“R” – Registration
Logged in by / Date
“E” – Mid Session
Mississippi Secretary of State
“E” – End-of-Session
Attn: LOBBYING
“A” – Lobbyist Annual Report
Lobbying Year
Physical:
“C” – Client Annual Report
401 Mississippi Street
Follow directions for extensions
Begin:
Jackson, Mississippi 39201
Lobbying Beginning
(No Earlier -Jan. 1)
Mailing:
Post Office Box 136
Jackson, Mississippi 39205-0136
End:
Lobbying Ending
(601) 359-6353 [phone] (601) 359-1499 [fax]
st
(No Later- Dec. 31
)
Lobbyists/Clients must notify our office if there are changes of addresses or phone numbers.
Write name of Client as it appears on “R” Registration Form. Do not abbreviate.
Certificate No. #
SECTION A: Registration Information
1.
LOBBYIST
Mid-Session Report (Form E)
End of Session Report (Form E)
2.
Cycle Year
3.
Type of Report:
Lobbyist’s Annual Report (Form A)
SECTION B: Benefiting Clients / Certificate Numbers
Cert.
Cert.
Cert.
Cert.
Client Name
Client Name
Client Name
Client Name
No.
No.
No.
No.
a.
a.
a.
a.
b.
b.
b.
b.
c.
c.
c.
c.
d.
d.
d.
d.
SECTION C: Itemized Expenditures
Recipient’s Office
Recipient
Date
Place
Provider
Description
Value/Cost
Title
a.
$
b.
$
$
c.
$
d.
$
e.
$
f.
$
g.
$
h.
$
TOTAL, this page
page ____ of____
Form XMC
[rev. Jul-05}

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