Attachment Form 640

Attachment to Form 635 or Form 645

For use by a state or local government agency that qualifies as a lobbyist employer or a $5,000 filer. Refer to the instructions page before completing this attachment.

Form 640 Instructions



Part 1 of 2: Other Payments to Influence Legislative or Administrative Action







Part 2 of 2: Itemized Payments of More Than $250

Itemize below payments of $250 or more made during the quarter for lobbying activity. Provide the name and address of the payee, the amount paid during the quarter, and the cumulative amount paid to the payee since January 1 of the biennial legislative session covered by the report.

Also itemize dues or similar payments of $250 or more made to an organization that makes expenditures equal to 10% of its total expenditures or $15,000 or more in a calendar quarter to influence legislative or administrative action. Provide the organization's name and address, the amount paid to the organization during the quarter, and the cumulative amount paid to the organization since January 1 of the biennial legislative session covered by the report.

Payment Row 1




Payment Row 2




Payment Row 3




Subtotal


(Continuation Sheet)

Payment Row 4




Payment Row 5




Payment Row 6




Payment Row 7




Payment Row 8




Payment Row 9




Payment Row 10




Payment Row 11




Payment Row 12




Subtotal


Please press 'Create PDF Document' button below. Filled out Form 640 PDF document will be opened. Please print page.


End of the Page, Form 640