Form X - Itemized Expenditures - Extension For "A" Or "C" Form - 2005
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1X
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE, Eric Clark
FORM
Itemized Expenditures – Extension for “A” or “C” Form
For office use only. Do not write in this
space.
Faxed reports must be followed by originals.
Please - no copies and no staples.
INSTRUCTIONS
:
How to locate forms on our website
1. Complete all information.
2. Form “X” is to be used with the Lobbyist’s Form “A”,
Elections
Or the Client’s Form “C” to itemized expenditures.
Lobbying
Logged in by / Date
Lobbying Forms Library
Mississippi Secretary of State
“R” – Registration
Attn: LOBBYING
“E” – Mid Session
Physical:
“E” – End-of-Session
Lobbying Year
401 Mississippi Street
“A” – Lobbyist Annual Report
Jackson, Mississippi 39201
“C” – Client Annual Report
Begin:
Lobbying Beginning
Mailing:
Follow directions for extensions
(No Earlier -Jan. 1)
Post Office Box 136
Jackson, Mississippi 39205-0136
(601) 359-6353 [phone] (601) 359-1499 [fax]
Lobbying Ending
End:
st
(No Later- Dec. 31
)
Lobbyists/Clients must notify our office if there are changes of addresses or phone numbers.
Write name of Client as it appears on “R” Registration Form. Do not abbreviate.
Certificate No. #
Registration Information
1.
LOBBYIST
2.
LOBBYIST’S CLIENT
3.
Certificate Number
4.
Cycle Year
5.
Type of
Lobbyist’s Annual Report (Form A)
Report
Lobbyist’s Client Annual Report (Form C)
Recipient
Recipient’s Office Title
Date
Place
Provider
Description
Value/Cost
a.
$
b.
$
$
c.
$
d.
$
e.
$
f.
$
g.
$
h.
$
i.
$
j.
$
k.
$
l.
$
m.
$
n.
$
o.
$
TOTAL, this page
page ____ of____
Form X
[rev. Jul-05}
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