PB ID
TELEPHONE NUMBER
NAME OF PUBLIC BODY
ADDRESS
CITY STATE ZIP CODE
SUMMARY OF EXPENDITURES
Total single expenditures on behalf of the Public Body whether or not made in the course of lobbying (Total from page 2):
• By a Designated Public Lobbyist
• By Authorized Public Lobbyists
Aggregate of expenditures of $20 or less on behalf of the Public Body whether or not made in the course of lobbying:
• By a Designated Public Lobbyist
• By Authorized Public Lobbyists
All expenditures by public body made in the course of lobbying to compensate or
reimburse Designated and Authorized Public Lobbyists for
expenses (Total from page 3)
Special Events (Total from page 4)
TOTAL EXPENDITURES (ADD ABOVE LINES)
PUBLIC BODIES ONLY:
BY CHECKING THE ABOVE BOX, I CERTIFY THAT THIS PUBLIC BODY HAS ESTABLISHED AND PREVIOUSLY FILED A TIME
ALLOCATION SCHEDULE FOR APPORTIONED LOBBYING ACTIVITY BASED ON ACTUAL EXPERIENCE. THERE HAS BEEN
NO CHANGE FROM PREVIOUS ANNUAL REPORTS IN THE COMPENSATION ATTRIBUTABLE TO LOBBYING FOR THE
DESIGNATED PUBLIC LOBBYIST AND ALL AUTHORIZED PUBLIC LOBBYISTS, AND THEIR JOB RESPONSIBILITIES HAVE
NOT BEEN SIGNIFICANTLY ALTERED SINCE THE TIME ALLOCATION SCHEDULE WAS ESTABLISHED.
I declare under penalty of perjury that the above information is true and correct.
Printed Name of Designated Public Lobbyist
PUBLIC BODY
REPORT YEAR
DESIGNATED PUBLIC LOBBYIST EMAIL ADDRESS
NAME OF DESIGNATED PUBLIC LOBBYIST
Conformed Signature of Designated Public Lobbyist
Page 1 of 4 A.R.S. § 41-1232.03
/S/
FILE ONLINE AT LOBBYING.AZ.GOV OR E-MAIL TO: LOBBYIST@AZSOS.GOV
