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NAME OF PUBLIC BODY
ID NUMBER
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO BE REIMBURSED (describe)
TYPE OF LOBBYIST (CHECK ONLY ONE)
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
NAME OF AUTHORIZED PUBLIC LOBBYIST
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO BE REIMBURSED (describe)
TYPE
OF LOBBYIST (CHECK ONLY ONE)
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
NAME OF AUTHORIZED PUBLIC LOBBYIST
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO BE REIMBURSED (describe)
TYPE OF LOBBYIST (CHE
CK ONLY ONE)
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
NAME OF AUTHORIZED PUBLIC LOBBYIST
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO
BE REIMBURSED (describe)
TYPE OF LOBBYIST (CHECK ONLY ONE)
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
NAME OF AUTHORIZED PUBLIC LOBBYIST
The Record of Lobbyists is only required if any lobbyists, other than the Designated Lobbyist, will be lobbying on behalf of the Principal/Public Body.