MAOF BALLET FOLKLORICO 1 - 2002 - Laserfiche WebLink

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1. Type of Federal Action: o a. contract b. grant c. cooperative agreement d.loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: o Prime 0 Subawardee Tier ____. if known: '-' DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 V.S.C. 1352 See reverse for ublic burden disclosure. 2. Status of Federal Action: 3. Report Type: Oa. bid/offer/application 0 a. initial filing b. initiai award b. materiai change c. post-award For Material Change Only: year quarter __ date of last report ...., Approved by OMS 0348.Q046 5. If Reporting Entity in No.4 is a Subawardee, Enter Name and Address of Prime: Con ressional District, if known: 6. Federal Department/Agency: Con ressional District, if known: 7. Federal Program Name/Description: CFDA Number. if applicab/e: 8. Federal Action Number, if known: 9. Award Amount, if known: $ b. Individuals Performing Services (including address if different from No. 1 Oa) (last name, first name, M/): 10. a. Name and Address of Lobbying Entity (if individual, last name, first name, M/): (attach Continuation Sheet(s) SF-LLLA. jf necessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ o actual o planned o a. retainer o b. one-time fee D c. commission o d. contingent fee o e. deferred o f. other; specify: 12. Form of Payment (check all that apply): o a. cash o b. in.kind; specify: nature value ____ 14. Brief Description of Services 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: (attach Continuation Sheet(s) SF-LLLA, If necessary) 15. Continuation Sheet s SF-LLLA attached: 0 Yes 0 No 16 Information requeliled Ihrough this fonn Is authorized by tiUe 31 U.s.C. MetJon Signature: . 1352. This dlsdosure of lobbying actlvilills Is a material repl'8l8l'lt8tlon of fact uponwhichreliancewasplacedbythetieraboYewhnVilltransactlonweslNlda P' t N or entered Into. This disclosure is required pUllluant to 31 U.S.C. 1352, this nn ame: informaUoo will be reported la \he Corvus HmJ..annualy and wlII be a".i1abl. for pubic lnspedJal. Ally pel'9)fI whO falls la file 1118 requFecl dlsdosul9 shall b8 Title: IUbfectto a cIvi1 penalty of not 1861 1hatS10,OOD and not more than S1OO.OOO for .."''''..~...., Telephone No.: , , Fe,deral US!! Only: Date: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)