Form 635 Report of Lobbyist Employer/Lobbying Coalition

Form 635 Instructions

Check one

Government Code Section 86116


2 California Code of Regulations Section 18616.4

Important: Lobbying Coalitions must attach a completed Form 635-C to this Report.


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

Part 1 of 5: Legislative or State Agency Administrative Actions Actively Lobbied During the Period

Summary of Payments This Period

F. Campaign Contributions (Check One):

Part 2 of 5: Partners, Owners, and Employees Whose "Lobbyist Reports" (Form 615) are Attached to This Report

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Row 1

Part 3 of 5: Payments Made in Connection with Lobbying

Section A: Payments to In-House Employee Lobbyists

Also Enter the Amount This Period on Line of the Summary of Payments Section

Section B: Payments to Lobbying Firms

Including Individual Contract Lobbyists.

Row 1 Lobbying Firm/Independent Contractor

Row 2 Lobbying Firm/Independent Contractor

Row 3 Lobbying Firm/Independent Contractor

Row 4 Lobbying Firm/Independent Contractor

Row 5 Lobbying Firm/Independent Contractor


Also enter this total on Line B of the Summary of Payments Section of Part 1.

Section C: Activity Expenses

Row 1 Activity Expense

Row 2 Activity Expense

Row 3 Activity Expense

Row 4 Activity Expense

Row 5 Activity Expense

Total for Section C

Also enter this total on Line C of the Summary of Payments Section of Part 1.

Section D: Other Payments to Influence Legislative or Administrative Action

Note: State and local government agencies do not complete this section.

Total for Section D

Also enter the total of Section D on Line D of the Summary of Payments Section of Part 1.

Section E: Payments in Connection with Administrative Testimony in Ratemaking Proceedings Before the California Public Utilities Commission

Also enter the total of Section E on Line E of the Summary of Payments Section of Part 1.

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.

Recipient Row 1

Recipient Row 2

Recipient Row 3

Recipient Row 4

Recipient Row 5

Recipient Row 6

Recipient Row 7

Recipient Row 8

Recipient Row 9

Recipient Row 10

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.

Signature of Employer or Responsible Officer Required. Please sign after printing.

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.

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