Laserfiche WebLink
Pt. 21, App. B 31 CFR Subtitle A (7-1-06 Edition) <br /> APPENDIX B TO PART 21—DISCLOSURE FOI{M To REPORT LOBBYING <br /> DISCLOSURE OF LOBBYING ACTIVITIES newer. O"'a <br /> 0.111,00,14 <br /> Complete this form to diccloce lobbying activities pursuant to 31 U.S.C.1154 <br /> (See reverse for public burden disclosure.) <br /> 1. Type of Federal Adban 2. Status of Federal Actio.e 3. Report Type <br /> ri a.contract a.biNuNer;application El a.initial filing <br /> b.grant b initial award b.material change <br /> c,cooperative agreement c.post award Foe Material Change Only: <br /> e. n.eoan ear <br /> e.loan guarantee a date of last repoquarter <br /> f. loan insurance 4. Name and Address of Reporting Entity: S. II Reporting Entity in No.4 is Subawardee.Enter Name <br /> ❑ Prime 0 Subawardee and Address M Prime: <br /> Tier ,d known. <br /> Congressional District r1 known _... Crmgtessinna'District.of known. <br /> & Federal DepsslmeokAgencr 7. Federal Program NarnelDescription: <br /> CFDA Number,of applwahle. <br /> & Federal Action Number,if known: 1. Award Amount.d known: <br /> II. a.None and Address of Lobbying b illy b.Individuals Performing Services Imrludrne.rddress of <br /> Id rndrwduai,fair rant,gist name.Alir: different(nom No.10.1 <br /> itast name.lest name,MTh <br /> lanutt Canoro oen}Mitt(St-tit A A MCI tt4nc <br /> I1. Amount of Payment(check all that applyl: tl.Type of Payment(cheek all that apply:: <br /> 0 actual C planned 0 a.retainer <br /> 0 b.onetime lee <br /> tI Form of Payment(check all that apply): 0 c.commission <br /> O a.cash 0 d,contingent fee <br /> ❑ b.irvkind:specify: nature — ❑ I deferred <br /> 0 1. other-.specify: <br /> value <br /> I.. Oriel Description of Services Performed m to be Performed and Dale1s)of Service,including officals).employees). <br /> Memberisl coMaated.for Payment Indic/And in Item I t: <br /> Iliad Cennnuaiwn sneaks)tfal]A of nerenanl <br /> IS. Condonation Shansi SP.LII'A coached: ❑Yes ❑No <br /> I. rn rearo.f mr'a.yrr a..brm n*.•aria:.on Ii 4..0 <br /> a]rl.n a.abaw l blar^Y aria..m a.a.ra rO..+++r+n Sig"... <br /> d 4t yen toNa r.a:MIN too Av.,root rM INint Name: <br /> .0*Nn a«wr.w non.00.0.rl w <br /> r l nn erbrs v.a!.ror.rM r nr CmPw.n.rr. <br /> Arra}and.1.eauaw b.r.sr mos.. <br /> an Hu nava.a Otto .014 Mal r. <br /> x®r.rr.rr er.n Otto mar eat...rrvw Telephone No: Dale <br /> Fedllt Use Oahe aMMrieM Iw Local I.pNw.ron <br /> Mandan/form•w <br /> 262 <br />