Form Xmc - Itemized Expenditures Benefiting Multiple Clients - Office Of The Mississippi Secretary Of State

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XMC
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 Expenditures Benefiting Multiple Clients
For office use only. Do not write in this space.
INSTRUCTIONS
:
1.
Use this form to report the total value/cost of an itemized expenditure to an individual
recipient per event, and the multiple clients who benefited from the itemized
expenditure.
2.
Report the name of the recipient, the recipient’s office title, the date, place, and
description of the expenditures. Report the Total Value/Cost per recipient. Report all
benefiting clients and each respective Certificate number.
3.
If you have no itemized expenditures, do not file this form.
4.
DO NOT use this form to record itemized receptions.
5.
ONLY individual names may be reported as the “Recipient.”
Itemized entry / date
6.
Each “Recipient” listed must have exactly the same Number and Names of “Benefiting
Clients” as the other recipients listed on this form. Use another Form XMC if recipient or
recipients have different benefiting clients.
SECTION A: Registration Information
1.
LOBBYIST
Mid-Session Report (Form E)
2.
Cycle Year
3.
Type of Report:
End of Session Report (Form E)
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.
SECTION C: Itemized Expenditures
Recipient’s Office
Recipient
Date
Place
Provider
Description
Value/Cost
Title
1.
$
2.
$
$
3.
$
4.
$
5.
$
6.
$
7.
8.
$
$
9.
$
10.
$
11.
$
12.
$
0.00
TOTAL, this page
page ____ of____
Form XMC
[rev. Jul-02}

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