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NAME
ID NUMBER
ENTITY TYPE
LOBBYIST - PRINCIPAL - PUBLIC BODY
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO BE REIMBURSED (describe)
Employee of
(Lobbying
Firm)
TYPE OF LOBBYIST (CHECK ONLY ONE)
Authorized Lobbyist
Lobbyist for Compensation
E-MAIL ADDRESS
PHONE NUMBER
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
/
PLEASE SUBMIT VIA EMAIL TO LOBBYIST@AZSOS.GOV
Authorized Public Lobbyist
SELECT ONE NAME OF LOBBYIST OR EMPLOYEE OF LOBBYING FIRM
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO BE
REIMBURSED (describe)
Employee of
(Lobbying
Firm)
TYPE OF LOBBYIST (CHECK ONLY
ONE)
Authorized Lobbyist
Lobbyist for Compensation
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
SELECT ONE
NAME OF LOBBYIST OR EMPLOYEE OF LOBBYING FIRM
ID NUMBER (IF AVAILABLE)
BUSINESS ADDRESS CITY STATE ZIP CODE
EXPENSES FOR WHICH LOBBYIST IS TO
BE REIMBURSED (describe)
Employee of
(Lobbying
Firm)
TYPE OF LOBBYIST (CHECK ONLY
ONE)
Authorized Lobbyist
Lobbyist for Compensation
E-MAIL ADDRESS
PHONE NUMBER
Authorized Public Lobbyist
SELECT ONE
NAME OF LOBBYIST OR EMPLOYEE OF LOBBYING FIRM
