DO NOT WRITE IN THIS SPACE
FOR OFFICE USE ONLY – REV. 12/26/18
State of Arizona
LOBBYIST REGISTRATION & RENEWAL
Initial Registration & Renewal Application
File with: Arizona Secretary of State
Attention: Election Services Division
1700 W. Washington Street, 7th Fl., Phoenix, AZ 85007
(602) 542-8683 (800) 458-5842 (within Arizona)
Website: www.azsos.gov
File this form between Dec. 1 of every odd-numbered year through the
second Monday of January of every even-numbered year. Refer to the
Lobbyist Handbook for more information.
INITIAL
LOBBYIST REGISTRATION ~ A.R.S. § 41-1232.05
Please type or print clearly.
BUSINESS ADDRESS CITY STATE ZIP CODE
CHECK ALL THAT APPLY:
DESIGNATED LOBBYIST
DESIGNATED PUBLIC LOBBYIST
LOBBYIST FOR COMPENSATION
STATE OF _________________________ )
)
COUNTY OF ________________________ )
ss
I, the undersigned, being duly sworn state that this Lobbyist Registration is complete, and that to the best of my knowledge and belief
the information above is true and correct.
____________________________________________________
Printed Name of Lobbyist
____________________________________________________
Signature of Lobbyist
SUBSCRIBED AND SWORN TO (Affirmed) before me on the ____ of _________________________, 20____
_________________________________
_________________________________
(affix seal)
IF REGISTRANT HAS EMPLOYEES WHO ACT AS LOBBYISTS, CHECK BOX AND ATTACH A COPY
OF THE RECORD OF LOBBYISTS LISTING THOSE EMPLOYEES.
I HAVE READ THE LOBBYIST HANDBOOK.
S:\Divisions\Elections\Lobbying\LOB_Reporting\Reporting Forms\2019
