NAME OF ENTITY
ID NUMBER TELEPHONE NUMBER
ONLY ENTER THE INFORMATION YOU WISH TO HAVE CHANGED IN THE SECTIONS BELOW
NEW NAME NEW TELEPHONE NUMBER
NEW ADDRESS NEW CITY NEW STATE NEW ZIP CODE
NEW E-MAIL ADDRESS
ENTITY TYPE
LOBBYIST - PRINCIPAL - PUBLIC BODY
By signing, I declare under penalty of perjury that the information provided on this form is true, complete, and correct.
Name
of
Designated Lobbyist/Lobbyist for Compensation
Conformed Signature of Designated Lobbyist/Lobbyist for Compensation
/S
/
FILE ONLINE AT LOBBYING.AZ.GOV OR E-MAIL TO: LOBBYIST@AZSOS.GOV
SELECT ONE