Orange County NC Website
Browse       Search
ATTTACH gNP B <br /> DISCLOSURE OF LOBBYING ACTIVITIE5 "0proi4 by°" <br /> c3,r-oos <br /> Complete this form to disdose lobbying activities pursuant to 31 U.S.C. 1352 <br /> (See reverse for public burden disclosure.) <br /> 1. Type of Federal Action: t Status of Federal Action: 3. Report Type: <br /> ❑ a. contract a. bid/o(fenappiication a. Initial filing <br /> b. grant ❑ b. Initial award ❑ b. material change <br /> C. cooperative agreement <br /> d. loan c. post-award For Material Change Only: <br /> e. loan guarantee year quarter <br /> I. loan insurance date of last report <br /> 4. Name and Address of Reporting Entity: S. U Reporting Entity In No.4 is Subawardee.Enter Name <br /> O Prime O Subawardee and Address of Prime <br /> Tier ,if known: <br /> Congressional District,if known: CongressionaLDIstrict,if known: <br /> 6. Federal Department/Age scy 7. Federal Program NamaiDesaiption: <br /> CFDA Number,if applicable: <br /> L Federal Action Number,it known: S. Award Amount.it known: <br /> f <br /> to. a. Name and Address of lobbying Entitt�yr b. Individuals Performen`Services(including address-of <br /> (if individual,last name, /first name,Mp: different from No. 10: <br /> (last name, first name, MO: <br /> r l <br /> 11. Amount of Payment(check all that apply): IS. Type of Payment(check all that apply): <br /> f O actual O planned O a. retalner <br /> O b. one-time fee _ <br /> 12. Form of Payment(chwk all that apply): O c. commission <br /> O a. ash O d. contingent fee <br /> Cl b. In-kind;specify:h� nature O e. deMed value O f. other,spedfy: <br /> 14. thief Description of Services Performed or to be Perfermed and Date(s)of Service.hududing offieer(sh employee(s). <br /> or Membeds)contacted.for Payment Indicated in Item t I: <br /> it n <br /> dwsavi <br /> IL Continuation Sheets)SF-LLL•A anacbe* O Yes O No <br /> IL ww wtr, quww dew.0 dw Mm h e>t.tl.rbd ti trb lr uiG <br /> ..ettew 1f37.11eN dheb.ten fi r ccdrldcc w •.ca.lcl.egwcwte,I, Signature.. <br /> d hct -p- ..Ad. -S-- ow pucd by the tb. A*" o"a th" <br /> v.s..etw.00 f""b P WNW"be.INS dkd@WAO is wmeded pw"W c is Print Name: <br /> 31 %&Lc. 1331 Trim YthMNS wl we be wPwd to dw CMewr nWA- <br /> MUMMO ad wd be tew-.. IM p+ac ItwP,9 , ,Mr p wew wow Icib w TKIe: <br /> IW dw-*Amd dkd—dW M r I @ , w a d a rweNp d tur bs 11MM <br /> Moo OW no owe dew tuaaro br turd►such bat. Telephone No» Date. <br /> 1%*r X sA1tr x.{ Atwl...i>7rr t«1.¢at a�.s�t,C+»w <br /> •ul <br />