Form 625 Report of Lobbying Firm

Government Code Section 86114

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

Form 625 Instructions


Part 1 of 5: Partners, Owners, Officers, and Employees Whose "Lobbyist Reports" (Form 615) are Attached to this Report, or Who Engaged in Direct Communitcation During the Period

Summary of Payments This Period

E. Campaign Contributions Made

F. Is This Firm a Member of a Coalition?

Part 2 of 5 : Payments Received in Connection With Lobbying Activity

Row 1 Payments Received

Row 2 Payments Received

Row 3 Payments Received

Subtotal For Part 2

Part 3 of 5: Payments Made in Connection With Lobbying Activities

Section A: Activity Expenses

1. Activity expenses arranged, incurred, or paid by the lobbying firm (other than those paid or incurred by a lobbyist).

Row 1 Activity Expenses

Row 2 Activity Expenses

Row 3 Activity Expenses

Row 4 Activity Expenses

Row 5 Activity Expenses

Row 6 Activity Expenses

Section A Continued

Section B: Payments Made to Other Lobbying Firms

Row 1 Payments Made

Row 2 Payments Made

Row 3 Payments Made

Row 4 Payments Made

Total Payments for Row 1 throught 4 plus subtotals for rows 5 through 8

Row 5 Payments Made

Row 6 Payments Made

Row 7 Payments Made

Row 8 Payments Made

Subtotal Payments for Row 5 through 8

Part 4 of 5: Campaign Contributions Made

Monetary and non-monetary campaign contributions of $100 or more made to or on behalf of state candidates, elected state officers and any of their controlled committees, or committees supporting such candidates or officers must be reported in A or B below.

Section A

If the contributions made by you during the period covered by this report, or by a committee you sponsor, are contained in a campaign disclosure statement which is on file with the Secretary of State, report the name of the committee and its identification number, if any, below.

Section B

Contributions of $100 or more which have not been reported on a campaign disclosure statement, including contributions made by an organization's sponsored committee, must be itemized below.

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

Row 1 of Campaign Contributions Made

Row 2 of Campaign Contributions Made

Row 3 of Campaign Contributions Made

Row 4 of Campaign Contributions Made

Row 5 of Campaign Contributions Made

Row 6 of Campaign Contributions Made

Row 7 of Campaign Contributions Made

Row 8 of Campaign Contributions Made

Row 9 of Campaign Contributions Made

Part 5 of 5: 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.

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