Form Xp - Itemized Receptions - Office Of The Mississippi Secretary Of State
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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 Receptions
For office use only. Do not write in this space.
INSTRUCTIONS
:
1.
Print or type all information. This form may be copied as needed.
2.
Use this form if you need additional space to list functions that meet the following
criteria:.
Each legislator and each statewide elected official receives an individual invitation.
The function begins and ends in one day.
All food and beverages are offered equally and are consumed in one day.
3.
All other food and beverage expenses must be individually itemized.
4.
If you have no itemized receptions, do not file this form.
Itemized entry / date
Registration Information
1.
LOBBYIST
2.
LOBBYIST’S CLIENT
3.
Certificate Number
4.
Cycle Year
5.
Type of Report
Lobbyist’s Annual Report (Form A)
Lobbyist’s Client Annual Report (Form C)
Estimated No. of
Estimated Total
Date
Place/Location
Total Cost
Public Officials
Attendance
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
8.
$
9.
$
10.
$
11.
$
12.
$
13.
$
14.
$
15.
$
16.
$
17.
$
18.
$
19.
$
0.00
TOTAL
$
, this page
page ____ of____
Form XP [rev. Jun-02}
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