Form Xl - Itemized Legislative Expenditures - Mississippi Secretary Of State

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XL
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
FORM
ERIC CLARK, Secretary of State,
401 Mississippi Street, Post Office Box 136, Jackson, Mississippi 39205-0136
Itemized Legislative Expenditures
INSTRUCTIONS
For office use only. Do not write in this space.
:
1.
Use this form if you need additional space for itemized expenditures on Form E,
“Lobbyist’s Legislative Expenditure Report.”
2.
Follow instructions for Form E, Section B, “Itemized Expenditures,” providing the
name of the recipient, the recipient’s office title, the date, place, provider,
description, and the value or cost of anything of value given or promised to a public
official or employee during the indicated period.
3.
If you have no itemized expenditures, do not file this form.
4.
This form may be copied as needed.
Itemized entry / date
5.
Only individual names may be reported as the “Recipient.”
Registration Information
1.
LOBBYIST
2.
LOBBYIST’S CLIENT
3.
Certificate Number
4.
Cycle Year
5.
Type of
Mid-Session (Legislative convening date through Feb. 25, due Feb. 25)
Report
End of Session (Feb. 25 through sine die, due 10 days after sine die)
Recipient
Recipient’s Office Title
Date
Place
Provider
Description
Value/Cost
1.
$
2.
$
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
11.
$
12.
$
13.
$
14.
$
15.
$
16.
$
17.
$
18.
$
19.
$
20.
0.00
$
TOTAL, this page
page ____ of____
Form XL [rev. Jun-02}

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