F. Acceptance of an electronic filing by the Secretary of State does not constitute an approval or endorsement of the
timeliness or the contents of the filing.
G. The Registrant, as the individual who is responsible under Arizona law for preparing and filing a report on behalf of a
principal with the Secretary of State, is responsible for complying with the provisions of Arizona Revised Statutes
Title 41, Chapter 7, Article 8.1. Registrants are responsible for ensuring that correct information is submitted to the
Secretary of State, and that amended reports or statements are timely filed in the event there is a change in any
required information.
H. A Registrant must allow sufficient time to submit filings. Filers should be aware that they are required by law to
submit timely filings with the Secretary of State, and that the Registrant should not wait until the last minute to make
a time-sensitive filing. A designated lobbyist or lobbyist for compensation which fails to file a report in a timely
manner may be held responsible under Arizona law for a violation, and may face the imposition of potentially serious
criminal and/or civil penalties, including fines and ineligibility to be a lobbyist or principal.
IT IS A CLASS 6 FELONY, PUNISHABLE BY FINE OR IMPRISONMENT, OR BOTH, UNDER A.R.S. § 13-
2407(A)(3), TO INTENTIONALLY FILE OR OFFER TO FILE WITH THIS AGENCY A STATEMENT WHICH IS
FALSELY MADE OR CONTAINS FALSE INFORMATION OR A FALSE ENTRY; AND THAT SUCH
INTENTIONAL FALSE STATEMENT MAY JEOPARDIZE THE VALIDITY OF ANY REPORT OR STATEMENT
FILED WITH THIS AGENCY.
IT IS A CLASS 6 FELONY, PUNISHABLE BY FINE OR IMPRISONMENT, OR BOTH, UNDER A.R.S. § 13-
2006(A) TO ASSUME A FALSE IDENTITY OR PRETEND TO BE A REPRESENTATIVE OF SOME PERSON OR
ORGANIZATION, WITH THE INTENT TO DEFRAUD ANOTHER; AND THAT SUCH INTENTIONAL
IMPERSONATION MAY JEOPARDIZE THE VALIDITY OF ANY REPORT OR STATEMENT FILED WITH THIS
AGENCY.
IT IS A CLASS 5 FELONY, PUNISHABLE BY FINE OR IMPRISONMENT, OR BOTH, UNDER A.R.S. § 13-
2311(A) TO DEFRAUD OR DECEIVE, TO KNOWINGLY FALSIFY, CONCEAL OR COVER UP A MATERIAL
FACT BY ANY TRICK, SCHEME OR DEVICE, OR MAKE OR USE ANY FALSE WRITING OR DOCUMENT
CONTAINING ANY FALSE, FICTITIOUS OR FRAUDULENT STATEMENT OR ENTRY, IN ANY MATTER
RELATED TO THE BUSINESS CONDUCTED BY THIS OR ANY DEPARTMENT OR AGENCY OF THIS STATE
OR POLITICAL SUBDIVISION, PURSUANT TO A SCHEME OR ARTIFICE; AND THAT SUCH FRAUDULENT
SCHEME AND PRACTICE BY WILLFUL CONCEALMENT MAY JEOPARDIZE THE VALIDITY OF ANY
REPORT OR STATEMENT FILED WITH THIS AGENCY.
3. SIGNATURE
The undersigned hereby acknowledges and declares that I have read and understand this REGISTRATION FORM and
STATEMENT; that I have used all reasonable diligence in preparing this statement; that all statements contained herein are true,
based upon information and belief upon the best available information; and further, that this Statement is made voluntarily and with
the knowledge that intentionally filing or attempting to file a false statement or false information, OR assuming a false identity or
impersonation another, OR willfully concealing a material fact pursuant to a fraudulent scheme or practice, and the like, are
punishable by fine or imprisonment, or both, under A.R.S. §§ 13-2407(A)(3), 13-2006 and 13-2311.
______________________________________________ _______________________________________________
Typed or Printed Name of Registrant Signature of Registrant
STATE OF ______________________________)
ss SUBSCRIBED AND SWORN TO (Affirmed) before me
COUNTY OF ______________________________) this _______ day of____________________, 20______
__________________________________ _________________________________________________
My Commission Expires Notary Public
