Orange County Specific Project Expenditure Report Form

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ORANGE COUNTY SPECIFIC PROJECT EXPENDITURE REPORT
ORANGE COUNTY SPECIFIC PROJECT EXPENDITURE REPORT
This lobbying expenditure form shall be completed in full and filed with all application submittals.
This form shall remain cumulative and shall be filed with the department processing your application.
Forms signed by a principal’s authorized agent shall include an executed Agent Authorization Form.
This is the initial Form:______
This is a Subsequent Form:______
For
Part I
staff
Please complete all of the following:
use
only
Name and Address of Principal (legal name of entity or owner per Orange County tax rolls): ____________
_______________________________________________________________________________________
Name and Address of Principal’s Authorized Agent, if applicable: _________________________________
_______________________________________________________________________________________
List the name and address of all lobbyists, consultants, contractors, subcontractors, individuals or
business entities who will assist with obtaining approval for this project. (Additional forms may be
used as necessary.)
1. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
2. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
3. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
4. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
5. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
6. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
7. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___
8. Name and address of individual or business
entity:___________________________________________
Are they registered Lobbyist? Yes __ or No___

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