Page 1 of 1 A.R.S. § 41-1232.05
LOBBYIST ID NUMBER
CITY STATE ZIP CODE
CHECK ALL THAT APPLY:
DESIGNATED LOBBYIST
DESIGNATED PUBLIC LOBBYIST
LOBBYIST FOR COMPENSATION
IF REGISTRANT HAS EMPLOYEES WHO ACT AS LOBBYISTS, CHECK BOX AND COMPLETE THE
RECORD OF EMPLOYEES FORM, LISTING THOSE EMPLOYEES.
I HAVE READ THE LOBBYIST HANDBOOK AND UNDERSTAND MY STATUTORY OBLIGATIONS.
I HAVE READ AND UNDERSTAND THAT ALL ELECTRONIC FILINGS ARE DEEMED TO BE FILED
UNDER PENALTY OF PERJURY IN ACCORDANCE WITH A.R.S. § 41-1232.07.
REGISTRATION TYPE:
NAME OF LOBBYIST/LOBBYING FIRM
E-MAIL ADDRESS
BUSINESS ADDRESS
LOBBYIST TYPE:
BUSINESS TELEPHONE
LOBBYIST
FILE ONLINE AT LOBBYING.AZ.GOV OR E-MAIL TO: LOBBYIST@AZSOS.GOV
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
/
