Form R - Lobbyist'S Registration Form Page 2
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2R
FORM
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SECTION C: Lobbyist Employment and Issues
Identify the level of government you will lobby on behalf of this
20. Lobbying BEGINNING
Month
Day
Year
lobbyist's client. Mark each that applies.
(No earlier than January 1.)
State
County
Municipality
Month
Day
Year
22. From the list below, identify the issue you will lobby for or against on
21. Lobbying ENDING
behalf of this lobbyist's client.
(No later than December 31.)
Oil & Gas Industry, Mining
Poultry, Livestock, & Fishing
Construction/Building/
Unions, Labor Issues, &
Exploration, Refining - Production,
Medicare/Medicaid
Industry – Production & Sales
Contracting/Real Estate Dev.
Special Advocacy Groups
Sales, & Services
Government (International,
Computers (Hardware, Software),
Educational Services,
Transportation -
Alcohol & Other Beverages
Federal, State, County, &
Multi Media Technology
Colleges, Technical Schools &
Trucking, Boats,
Tobacco Industry
Municipal)
Technical Services & Support
Trade Schools
Airplanes, & Rails
Agriculture, Forestry, Timber, &
Insurance Industry - Home,
Manufacturing - Retail &
Financial Institutions,
Utilities (Electric,
Hunting - Production, Sales, &
Auto, Health & Life. Services
Wholesale Industry
Investment Firms & Related Services
Gas, Water, Nuclear)
Leases
and Sales
Scientific/Medical
Charities & Social Services.
Health Care /Nursing Homes/
Corrections, Public Safety,
Business – Private & Commercial
Research & Dev.
Church & Com. related Outreach.
Hospice/ Elderly/Hospital Care
& Security Services
Enterprises
Gaming, Arts, Entertainment,
Pharmaceutical Industry –
Environmental Quality, Wildlife
Alternative Health
Waste (Solid &
Hotels, Restaurants, &
Research, Production, &
Preservation, Land Conservation, &
Care/Holistic Medicine
Hazardous)
Recreational Facilities
Sales
Historical Preservation.
Telecommunications/
Homeland Security
Aerospace/Space Technology
Satellite Systems/ Related
Military/Veterans Issues
International Trade
Services
Identify “Other” Lobbying Issues not shown above:
21. Identify all other lobbyists in Mississippi employed by this client. Attach separate sheet if needed.
Lobbyist’s Name
Certificate No.
Address
Telephone
_______________________________
__________
___________________________________
________________________
_______________________________
__________
___________________________________
_________________________
_______________________________
__________
___________________________________
_________________________
IMPORTANT
•
Miss. Code Ann., § 5-8-5 (1) (1972) states every lobbyist registration shall be filed “with the Secretary of State within five (5) calendar days
after becoming a lobbyist, becoming a lobbyist’s client or beginning to lobby for a new client.”
•
Miss. Code Ann., § 5-8-17 (1)(b) (1972) states beginning with the tenth (10) day after which any report is due, “the Secretary of State shall
assess the delinquent lobbyist and delinquent lobbyist’s client a civil penalty of Fifty Dollars ($50.00) per day and part of any day until a valid
report is delivered to the Secretary of State, up to a maximum of ten (10) days.
•
Miss. Code Ann., §5-8-21(1972) provides a conviction for violation of the lobbying law, for the first offense, carries a penalty of a maximum
of six (6) months in jail and a fine of One Thousand Dollars ($1,000); and for subsequent offenses a maximum of three (3) years in the
penitentiary and a fine of Five Thousand Dollars ($5,000).
IMPORTANT DATES TO REMEMBER
•
th.
MID-SESSION REPORTS (FORM E) DUE FEBRUARY 25
•
END-OF-SESSION REPORTS (FORM E) DUE TEN (10) DAYS AFTER THE LEGISLATURE’S ADJOURNMENT, SINE DIE.
•
th.
LOBBYIST’S ANNUAL REPORTS (FORM A) AND LOBBYIST’S CLIENT ANNUAL REPORTS (FORM C) DUE JANUARY 30
Signatures
Print LOBBYIST’S Name Here.
Print LOBBYIST’S CLIENT Name Here.
Signature
Signature
Date
Date
RETURN SIGNED, COMPLETED FORM AND $25.00 FEE TO:
Mississippi Secretary of State’s Office
Attn: Lobbyist Registration
401 Mississippi Street
Post Office Box 136
Jackson, Mississippi 39201
Jackson, Mississippi 39205-0136
Form R [rev. Jul-05]
Page 2 of 2
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