Louisiana Administrative Code
Title 52 - ETHICS
Part I - Board of Ethics
Chapter 19 - Legislative Branch Lobbyist Disclosure Act
Section I-1907 - Lobbying Registration Form

Universal Citation: LA Admin Code I-1907
Current through Register Vol. 49, No. 12, December 20, 2023

LOBBYING REGISTRATION FORM

To be used for initial registrations and renewals

_____________________

Lobbyist's Registration Number

FOR OFFICE USE ONLY

Postmark Date:______

· Print in ink or type.

· Complete form and return with $110 registration fee to the Board of Ethics,2415 Quail Dr. , 3rd Floor, Baton Rouge , LA 70808 , (225) 763-8777 or (800) 842-6630.

· Initial registrations must be submitted within 5 days of (1) employment as a lobbyist or (2) first action requiring registration. Registrations expire as of December 31 unless a renewal is submitted between December 1 and January 31 .

1. NAME_____________________________________________________

Last First MI

2. BUSINESS PHONE___________________________________________

Area Code and Phone Number

3. BUSINESS ADDRESS____________________________________________________________

Street and No. City State Zip

MAILING ADDRESS_____________________________________________________________

Street and No. City State Zip

4. EMPLOYER____________________________________________________

5. EMPLOYER'S ADDRESS___________________________________________________________

Street and No. City State Zip

6. LIST BELOW (a) Names of persons, groups, or organizations which you represent; (b) the address of each such person, group, or organization you represent; (c) the type of business each is engaged in or the purpose or function of the organization or group; (d) whether or not the client or someone else pays you to lobby.

1. Name_________________________________________________________

Address_______________________________________________________

Business or purpose______________________________________________

Does this person pay you? _____

If No, then who pays you?_________________________________________

2. Name_________________________________________________________

Address_______________________________________________________

Business or purpose______________________________________________

Does this person pay you? _____

If No, then who pays you?_________________________________________

3. Name_________________________________________________________

Address_______________________________________________________

Business or purpose______________________________________________

Does this person pay you? _____

If No, then who pays you?_________________________________________

4. Name_________________________________________________________

Address_______________________________________________________

Business or purpose______________________________________________

Does this person pay you? _____

If No, then who pays you?_________________________________________

CERTIFICATION OF ACCURACY

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 the Lobbyist Disclosure Act [LSA-R.S. 24:50 et seq.] has been deliberately omitted.

_________________________________________

Signature of Lobbyist

ATTACH

2" x 2"

PHOTOGRAPH

HERE

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2680 (December 2004), repromulgated LR 31:627 (March 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 42:1134(A).

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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