Form R - Lobbyist'S Registration Form - Office Of The Mississippi Secretary Of State Page 2

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FORM

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SECTION C: Lobbyist Employment and Issues

17. Lobbyist’s Occupation

18. Identify the level of government you will lobby on behalf of this lobbyist's client.

Month

Day

Year

19. Lobbying BEGINNING

State

(No earlier than January 1.)

Municipal/County

Month

Day

Year

20. Lobbying ENDING

Both

(No later than December 31.)

21. From the list below, identify the issue you will lobby for or against on behalf of this lobbyist's client.

Agriculture, Farming Livestock

Gaming, Tourism, Hotels &

Insurance & Insurance

Telecommunications &

Contracting and Building

and Poultry

Restaurants

Providers

Information Systems

Alcohol & Other Beverages

Corrections

Government & Governmental

Labor Issues

Tobacco

Issues

Business, Development &

Education

Health Care

Oil & Petroleum

Utilities (Electric, Water, Rail, etc.)

Financial

Charities, Citizens Groups &

Environment, Wildlife &

Industrial Issues

Other, Miscellaneous

Waste (Solid and Hazardous)

Social Services

Forestry

22. Identify all other lobbyists in Mississippi employed by or associated with this lobbyist’s client. Attach separate sheet if needed.

Name

Address

Telephone

________________________________________

_______________________________________________

_________________________________

________________________________________

_______________________________________________

_________________________________

________________________________________

_______________________________________________

_________________________________

________________________________________

_______________________________________________

_________________________________

IMPORTANT

• • • •

Miss. Code Ann., § 5-8-5 (1) (1972) states every lobbyist registration shall be filed “with the Secretary of State within five (5) calendar days after

becoming a lobbyist, becoming a lobbyist’s client or beginning to lobby for a new client.”

• • • •

Miss. Code Ann., § 5-8-17 (1)(b) (1972) states beginning with the tenth (10) day after which any report is due, “the Secretary of State shall assess the

deliquent lobbyist and delinquent lobbyist’s client a civil penalty of Fifty Dollars ($50.00) per day and part of any day until a valid report is delivered

to the Secretary of State, up to a maximum of ten (10) days.

• • • •

Miss. Code Ann., §5-8-21(1972) provides a conviction for violation of the lobbying law, for the first offense, carries a penalty of a maximum of six

(6) months in jail and a fine of One Thousand Dollars ($1,000); and for subsequent offenses a maximum of three (3) years in the penitentiary and a

fine of Five Thousand Dollars ($5,000).

IMPORTANT DATES TO REMEMBER

• • • •

th.

FORM E MID-SESSION REPORTS ARE DUE ON FEBRUARY 25

• • • •

FORM E END-OF-SESSION REPORTS ARE DUE WITHIN TEN (10) DAYS AFTER THE LEGISLATURE’S

ADJOURNMENT SINE DIE.