Fillable PRINCIPAL/PUBLIC BODY DESIGNATED PUBLIC LOBBYIST CHANGE DESIGNATED LOBBYIST/ (Arizona Secretary of State)

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PRINCIPAL/PUBLIC BODY DESIGNATED PUBLIC LOBBYIST CHANGE DESIGNATED LOBBYIST/ (Arizona Secretary of State)

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FOR OFFICE USE ONLY – REV. 12/26/19
State of Arizona
PRINCIPAL/PUBLIC BODY
CHANGE DESIGNATED LOBBYIST/
DESIGNATED PUBLIC LOBBYIST
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
CHANGE DESIGNATED LOBBYIST/ DESIGNATED PUBLIC LOBBYIST ~ A.R.S. §§ 41-1232 (C), 41-1232.01 (C)
_____________________________________________________________________________________________
NAME OF PRINCIPAL/PUBLIC BODY
__________________________________________________________
PRINCIPAL/PUBLIC BODY ID #
NEW DESIGNATED LOBBYIST/DESIGNATED PUBLIC LOBBYIST
LOBBYIST ID NUMBER
BUSINESS ADDRESS CITY STATE ZIP CODE
E-MAIL ADDRESS
BUSINESS TELEPHONE
BUSINESS FAX
EXPENSES FOR WHICH LOBBYIST IS TO BE REIMBURSED (CHECK ALL THAT APPLY)
Meals Travel Lodging Out Of Pocket Expenses
Other (Please describe) ___________________________________________________
E-MAIL ADDRESS
STATE OF _________________________ )
)
COUNTY OF ________________________ )
ss
I, the undersigned, being duly sworn state that this Principal / Public Body Registration Amendment is complete, and that to the best
of my knowledge and belief the information above is true and correct.
____________________________________________________
Printed Name of Designated Lobbyist/Designated Public Lobbyist
____________________________________________________
Signature of Designated Lobbyist/Designated Public Lobbyist
SUBSCRIBED AND SWORN TO (Affirmed) before me on the ____ of _________________________, 20____
_________________________________
My Commission Expires
_________________________________
Notary Public
(affix seal)
D
O
N
OT
W
RITE IN
T
HIS
S
PACE
Office Form S:\Divisions\Elections\Lobbying\LOB_Reporting\Reporting Forms\2019\PPB_Change_Designated_Lobbyist.doc
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PRINCIPALPUBLIC BODY DESIGNATED PUBLIC LOBBYIST CHANGE DESIGNATED LOBBYIST (Arizona Secretary of State)

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Completed 20 July 2020

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