NAME OF PRINCIPAL/PUBLIC BODY PRINCIPAL/PUBLIC BODY ID
DESIGNATED LOBBYIST/DESIGNATED PUBLIC LOBBYIST LOBBYIST ID
YOUR TERMINATION CANNOT BE FILED WITHOUT THE
PRINCIPAL/PUBLIC BODY’S FINAL ANNUAL REPORT.
Upon submission of this form the principal or public body hereby terminates its registration for
lobbying and the engagement and authority of any and all lobbyists named in its registration.
PRINCIPAL - PUBLIC BODY
By signing, I declare under penalty of perjury that the information provided on this form is true, complete, and correct.
Name of Designated Lobbyist
Conformed Signature of Designated Lobbyist
FILE ONLINE AT LOBBYING.AZ.GOV
OR E-MAIL TO:
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A.R.S. § 41-1232 (C)