Fillable PRINCIPAL/PUBLIC BODY/LOBBYIST Registration Amendment (Arizona Secretary of State)

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PRINCIPAL/PUBLIC BODY/LOBBYIST Registration Amendment (Arizona Secretary of State)

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DO NOT WRITE IN THIS SPACE
FOR OFFICE USE ONLY – REV. 1/05/15
State of Arizona
PRINCIPAL/PUBLIC BODY/LOBBYIST
Registration Amendment
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 to indicate a change in the legal name of principal/public
body or individual. To change designated lobbyist or designated
public lobbyist, use the “change of designated lobbyist” form.
PRINCIPAL
PUBLIC BODY
LOBBYIST
REGISTRATION AMENDMENT - CHANGE OF NAME OR ADDRESS
Please type or print clearly.
NAME OF PRINCIPAL/PUBLIC BODY
PRINCIPAL/PUBLIC BODY ID
E-mail Address
NAME OF LOBBYIST
LOBBYIST ID#
E-mail Address
TO CHANGE THE NAME, MAILING ADDRESS OR E-MAIL ADDRESS OF A PRINCIPAL, PUBLIC BODY OR
LOBBYIST, FILL IN ONLY THE NEW INFORMATION IN BOXES BELOW.
NEW NAME OF PRINCIPAL OR PUBLIC BODY
NEW FAX #:
NEW ADDRESS OF PRINCIPAL OR PUBLIC BODY CITY STATE ZIP CODE
NEW E-mail Address
NEW NAME OF LOBBYIST
NEW FAX #:
NEW ADDRESS OF LOBBYIST CITY STATE ZIP CODE
NEW 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)
Office Form S:\Divisions\Elections\Lobbying\LOB_Reporting\Reporting Forms\2019
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PRINCIPALPUBLIC BODYLOBBYIST Registration Amendment (Arizona Secretary of State)

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Completed 20 July 2020

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