Statement of Lobbying Expenditures

This form must be submitted annually by January 15 for the prior calendar year. Failure to timely file the expenditure report will result in the lobbyist’s registration being suspended until the delinquent expenditure report is filed.

Statement for Calendar Year(Required)

(This annual statement is mandatory and due on by JANUARY 15 for the prior calendar year, whether or not there are expenditures.)

Lobbyist First Name(Required)

Lobbyist Last Name(Required)

Lobbyist Firm(Required)

Email(Required)

Phone(Required)

Address 1(Required)

Address 2

City(Required)

State(Required)

ZIP Code(Required)

Report Disclosure Type – Select One(Required)

There are NO expenditures

This is an UPDATED statement

There are reportable lobbying expenditures. (If selected, disclose the expenditures, below.)

Itemized Expenditures

If in person, Meeting location:	Meeting Format	Actions

There are no Entries.

Affirmation

By typing my name below and submitting his form, I affirm that the information above is true and correct to the best of my knowledge. , and that I have read and agree to comply with the terms of Chapter 26, Article IX of the Pinellas County Code, entitled “LOBBYISTS.”

Full Name(Required)

Date(Required)

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Statement of Lobbying Expenditures

Affirmation