Lobbyist Registration Form – Village of Sea Ranch Lakes

Village of Sea Ranch Lakes Lobbyist Registration Statement

“Lobbyist” shall be defined as any person or persons employed or retained, paid by a principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any council member: any action, decision, recommendation of the Mayor or any village council member: or any action, decision or recommendation of any village personnel during the time period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the Village Council, or a Village board. The term specifically includes the principal as well as any employee engaged in lobbying activities.

A separate Lobbyist Registration Statement must be filed for each different principal or client, and each different subject matter of the lobbying issues.
A Lobbyist Registration Statement must be filed prior to any lobbying activities.
A Lobbyist Registration Statement is valid until December 31st. New Statements must be filed annually as of January lst.

Lobbyist Form

Is this an Amendment of a previously filed registration? *

Yes

Lobbyist Name *

First

Last *

Last

Phone Number *

Fax

Email *

Business Name *

Business Address *

City *

State *

Postal Code *

Residence Address *

City *

State *

Postal Code *

Lobbyist Retained by: *

Name of Principal/Client

Phone Number *

FAX Number

Email *

Business Address *

City *

State *

Postal Code

Nature of Business

Fill out this section, if principal is a Corporation, Partnership, or Trust

Name of Chief Officer, Partner, or Beneficiary

General and specific subject matter of Lobby Issue(s).

Specify the extent of any direct business association by the lobbyist with any current elected or appointed official or employee of the Village of Sea Ranch Lakes. For the purposes of this Article, the term "direct business association" shall mean any mutual endeavor undertaken for profit or compensation.

A lobbyist representing a group, association, or organization shall, prior to engaging in lobbying, receive appropriate authorization from said group, association, or organization to lobby on its behalf upon a particular subject matter. Please provide a copy of the applicable minutes, motion, or other documentation of action. The lobbyist is the General Counsel of the organization and has authority by reason of his position.

City Agencies/Individuals to be lobbied

Full Name(s) of Individual/Title(s)

Any Financial, Familial or Professional Relationship with anyone listed in subpart?

Yes

Disclosure of terms and amounts of lobbyist compensation (disclose whether hourly, flat rate contingency or other)

“Contingency fee” means a fee, bonus, commission, or non-monetary benefit as compensation, which is dependent, or in any way contingent on the enactment, defeat, modification, or other outcome of any specific action of the Village Council.

Under Oath *

I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Sections 2-3 of the Code Ordinances of the Village of Sea Ranch Lakes and all reporting requirements.

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