Lobbyist Report Form 615

Government Code Section 86113

IMPORTANT: This report is to be completed by the lobbyist and attached to the Report of Lobbying Firm (Form 625) or Report of Lobbyist Employer/Report of Lobbying Coalition (Form 635), whichever is applicable.

For information required to be provided to you pursuant to the Information Practices Act of 1977, see Information Manual on Lobbying Disclosure Provisions of the Political Reform Act.

Form 615 Instructions

 
 










Part 1 of 3: Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist




Row 1 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 2 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist








Row 3 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 4 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 5 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 6 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 7 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 8 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row 9 Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist







Row Ten Activity Expenses Paid, Incurred, Arranged, or Provided by the Lobbyist








Part 2 of 3: Campaign Contributions Made or Delivered

I have reviewed this form and instructions for reporting Campagin Contributions Made or Delivered and (check one box):



Disclose all monetary and non-monetary campaign contributions of $100 or more made from your personal funds during the quarter, or from a separate account under your control, to state candidates, elected state officers, their controlled committees, or committees primarily formed to support such officers or candidates, or delivered in person by you to state candidates or elected state officers.

Note: Disclosure in this report does not relieve a filer of any obligation to file campaign disclosure statements required by Government Code Section 84200, et seq.

Row 1 Campaign Contribution Made or Delivered







Row 2 Campaign Contribution Made or Delivered







Row 3 Campaign Contribution Made or Delivered







Row 4 Campaign Contribution Made or Delivered







Row 5 Campaign Contribution Made or Delivered







Row 6 Campaign Contribution Made or Delivered







Row 7 Campaign Contribution Made or Delivered







Row 8 Campaign Contribution Made or Delivered







Part 3 of 3: Verification

I have used all reasonable diligence in preparing this Report. I have reviewed the Report and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.


Signature of Lobbyist Required. Please sign after printing.

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End of the Page, Form 615