La. Admin. Code tit. 52 § I-2135

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2135 - Executive Lobbying Expenditure Reporting Designation

EXECUTIVE LOBBYING EXPENDITURE REPORTING DESIGNATION

Pursuant to LSA-R.S. 49:76G(2)(a), an employer or principal of a lobbyist may elect to file the Lobbying Expenditure Reports as required by Title 49 on behalf of all of its lobbyists. The designation form is to be completed and submitted by January 31st of each year. This designation will be effective for the reporting of all expenditures made during that calendar year. This form must include a listing of all persons for whom you will be reporting. Also, please list a contact person who will be responsible for completing such reports and for receiving any correspondence regarding reporting deadlines and late fees. Failure to fully complete this form may render your designation ineffective.

Hand deliver or mail to : 2415 Quail Drive , 3rd Floor, Baton Rouge , LA 70808 OR Fax to : (225) 763-8787 or (225) 763-8780

FOR OFFICE USE ONLY Postmark Date_________

1. EMPLOYER/PRINCIPAL ____________________________________________________________

2. BUSINESS ADDRESS ______________________________________________________________

Street and No. City State Zip

MAILING ADDRESS _______________________________________________________________

Street and No. City State Zip

3. CONTACT PERSON: _______________________________________________________________

Last First MI

4. MAILING ADDRESS _______________________________________________________________

(If different from above) Street and No. City State Zip

5. PHONE NUMBER _________________________________________________________________

Area Code and Phone Number

6. FAX NUMBER ____________________________________________________________________

Area Code and Fax Number

7. Names of Lobbyists who are employed by or who represent the interests of the Principal listed above:

1) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

2) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

3) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

4) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

5) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

6) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

7) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

8) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

9) Name: _________________________________________________ EXEC.ID.#_______________

Last First MI

10) Name: ________________________________________________ EXEC.ID.#_______________

Last First MI

Pursuant to LSA-R.S. 49:76G(2)(a), ______________________________________ (name of employer or principal) is exercising the option of filing expenditure reports for all executive lobbying expenditures made of my/its behalf by persons representing my/its interests during the year of _________. I hereby certify that the information contained herein is true and correct to the best of my knowledge, information and belief; and that no information required by LSA-R.S. 49:71 et seq. has been deliberately omitted.

___________________________________________

Signature of Employer/Principal or Representative

___________________________________________

Print of Type Full Name

La. Admin. Code tit. 52, § I-2135

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2694 (December 2004 repromulgated LR 31:1241 (June 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 42:1134(A).