Louisiana Administrative Code › Title 52 - ETHICS › Part I - Board of Ethics › Chapter 21 - Executive Branch Lobbyist Disclosure Act › Section I-2135 - Executive Lobbying Expenditure Reporting Designation

Current through Register Vol. 50, No. 6, June 20, 2024
EXECUTIVE LOBBYING EXPENDITURE
REPORTING DESIGNATION
Pursuant to LSA-R.S.
							 49:76 G(2)(a), an employer or principal of a
							 lobbyist may elect to file the Lobbying Expenditure Reports as required by
							 Title 49 on behalf of
all
of its
							 lobbyists. The designation form is to be completed and submitted by
January 31st
of each year. This
							 designation will be effective for the reporting of all expenditures made during
							 that calendar year. This form must include a listing of all persons for whom
							 you will be reporting. Also, please list a contact person who will be
							 responsible for completing such reports and for receiving any correspondence
							 regarding reporting deadlines and late fees. Failure to fully complete this
							 form may render your designation ineffective.
Hand deliver or mail to
:
2415 Quail Drive
, 3rd Floor,
Baton Rouge
,
LA
70808
OR
Fax to
:
(225)
							 763-8787 or (225) 763-8780
FOR OFFICE USE ONLY
Postmark Date_________
1.
				EMPLOYER/PRINCIPAL
				____________________________________________________________
2. BUSINESS ADDRESS
				______________________________________________________________
Street and No. City State Zip
MAILING ADDRESS
				  _______________________________________________________________
Street and No. City State Zip
3. CONTACT PERSON:
				_______________________________________________________________
Last First MI
4. MAILING ADDRESS
				_______________________________________________________________
(
If different from above
) Street and No.
				  City State Zip
5. PHONE
				NUMBER _________________________________________________________________
Area Code and Phone Number
6. FAX NUMBER
				____________________________________________________________________
Area Code and Fax Number
7. Names of Lobbyists who are employed by or
				who represent the interests of the Principal listed above:
1) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
2) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
3) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
4) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
5) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
6) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
7) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
8) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
9) Name:
				_________________________________________________ EXEC.ID.#_______________
Last First MI
10) Name:
				________________________________________________ EXEC.ID.#_______________
Last First MI
Pursuant to LSA-R.S.
				  49:76 G(2)(a),
				  ______________________________________ (name of employer or principal) is
				  exercising the option of filing expenditure reports for all executive lobbying
				  expenditures made of my/its behalf by persons representing my/its interests
				  during the year of _________. I hereby certify that the information contained
				  herein is true and correct to the best of my knowledge, information and belief;
				  and that no information required by LSA-R.S.
				  49:71 et seq. has been deliberately
				  omitted.
___________________________________________
Signature of Employer/Principal or
				  Representative
___________________________________________
Print of Type Full Name
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  42:1134(A).