LEGAL AID SOCIETY OF ORANGE COUNTY, INC. 8 -2002

Home Browse Search

, .,.~,.. "'~ .... c.;:.~ f "-' """" Disclosure of Lobbying Activities Approved by OMS 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse side for Instructions and Public Reporting burden statement) 1. Type of Federal Action 2. Status of Federal Action 3. Report Type 08. contract o a. bid/offer/application o a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only d. loan year (yyyy) quarter ____ e. loan guarantee f. loan insurance date of last report (mm/dd/YYYYl_____ 4. Name .nd Addressiof Reporting Entity 5. If Reporting Entity In No.4 Is SUbawardee, enter Name and Address o Prime D Subawardee Tier __, if known: of Prime Congressional District, if known Congressional District, if known 6. Federal Department/Agency 7. Federal Program Name/Descrlption - CFDA Number, if applicable - 8. Federal Action Number, if known 9. Award Amount, if known $ 10a. Name and Address of Lobbying Registrant b. Individuals Perfonning Services (induding address if different from No. 10a.) (if individual, last name, first name, MI) (last name, first name, MI) 11. Amount of Payment (check all that apply) (attach continuation sheet(s) if necessary) 13. Type of Payment (check all that apply) $ D a. retainer D b. one.time fee D c. commission D d. contingent fee D e. deferred o f. other (specify) Brief Description of SelVices Performed or to be Performed and Date(s) of Service, Including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11 actual planned 12. Form of Payment (check all that apply) Da Db cash in-kind; specify: nature value 14. (attach continuation sheet(sl if necessary) 15. Continuation sheets attached 0 Yes D No 16. Information requested through this form is authorized by Sec.319, Pub. L. 101-121. 103 Stat. 750, as amended by sec. 10; Pub. L. 104- 65. Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semiannually and will be availabie for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature Print Name Title Telephone No. Date (mmlddlyyyy) Authorized for Local Reproduction Standard Form~LLL (7/97) Federal'UseOnly: