Louisiana Administrative Code
Title 52 - ETHICS
Part I - Board of Ethics
Chapter 21 - Executive Branch Lobbyist Disclosure Act
Section I-2131 - Executive Lobbying Registration/Renewal

Universal Citation: LA Admin Code I-2131

Current through Register Vol. 49, No. 12, December 20, 2023

EXECUTIVE LOBBYING REGISTRATION/ RENEWAL FOR

THE YEAR OF ______________

(Fill in year.)

________________________________

Executive Lobbyist Registration No.

FOR OFFICE USE ONLY

Postmark Date:__________

Instructions

. 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 , or fax to (225) 763-8787. For information or assistance, call (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. FAX NUMBER___________________________________________________________________

4. BUSINESS ADDRESS _____________________________________________________________

Street and No. City State Zip

MAILING ADDRESS ______________________________________________________________

Street and No. City State Zip

5. EMPLOYER _____________________________________________________________________

6. EMPLOYER'S ADDRESS ___________________________________________________________

Street and No. City State Zip

7. LIST BELOW (a) Names of persons, groups, or organizations which you represent and on whose behalf expenditures are made; (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, who pays you?___________________________________________________________

EXECUTIVE LOBBYING REGISTRATION FORM

______________________________

Executive Lobbyist Registration No .

2. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you?______________________________________________________

If No, who pays you? __________________________________________________________

3. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ___________

If No, who pays you? __________________________________________________________

4. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ___________

If No, 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 LSA-R.S. 49:71 et seq. has been deliberately omitted.

____________________________ Signature of Lobbyist

ATTACH

2" x 2"

PHOTOGRAPH

HERE

EXECUTIVE LOBBYING REGISTRATION/RENEWAL ATTACHMENT FORM

________________________________

Executive Lobbyist Registration No.

Instructions:

· Please make as many copies of this form as necessary in order to complete Question 7 of the Executive Lobbying Registration/Renewal Form.

· Fill in your Executive Lobbyist Registration No. in the space provided in the upper right hand corner of the page.

· Please identify each page with a page number and indicate the total number of pages being submitted.

1. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ______________________________________________________

If No, who pays you? __________________________________________________________

2. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ______________________________________________________

If No, who pays you?___________________________________________________________

3. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ______________________________________________________

If No, who pays you? __________________________________________________________

4. Name ______________________________________________________________________

Address ____________________________________________________________________

Business or purpose ___________________________________________________________

Does this person pay you? ______________________________________________________

If No, who pays you? __________________________________________________________

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2689 (December 2004), repromulgated LR 31:1236 (June 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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