St. JOSEPH BALLET 4 - 2002 - Laserfiche WebLink

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'- DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 V.S.C. 1352 ....., Approved by OMa 0346-0046 'See reverse for Dublic burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: o a. contract Oa. bid/offer/application o a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d.loan year quarter ____ e. loan guarantee date of last report f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 Is a Subawardee, Enter Name o Prime o Subawardee and Address of Prime: Tier ____, If known: Conaressional District, if known: Conaressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, If applicable: ______ 8. Federal Action Number, if known: 9. Award Amount, if known: $ 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if (if individual, last name, first name, M/): dlfferentfrom No. 1 Oa) (last name, first name, M/): (anach Continuation Shaatls) SF-LLLA. if necessary! 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ ------ o actual o planned o a. retainer o b. one.time fee 12. Form of Payment (check all that apply): o c. commleelon o a. cash o d. contingent fee o b. in.kindj specify: nature ------- o e. deferred value o f. other; specify: 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: laffach Continuation Sheans} SF-LLLA, i( necessary} 15. Continuation Sheet/s) SF-LLLA attached: OVee DNa 16 Infonnatlon requested through this form II authorized by liDe 31 U.S.C. section Signature: . 1352. This dlBdosur& of lobbying actMlies II 8 materiall'8preeentallon of fad upon which reliance was placed by the tier abovawhen this Inmsadion w.. made Print Name: or IIfllered Into. This dllldosure II required pUllIuanl to 31 U.S.C. 1352. This Informatla1 will be reported to the Corvess semi-annullly and wll be available for Title: pubic ln8pectlm. Any person who fanl 10 file the required dlSdolure Ihall be wbject eo 8 clvn penelty of not less that $10,000 and not mCIr8 than .tOO,OOO for Telephone No.: Date: eachauctlfaUure. . .... .. ... ......... :. -.1 Authorized for Local Reproduction FederallJs~ Only: . . .. .. ... .. . . . Standard Form LLL (Rev. 7-97) -