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37 <br /> DISCLOSURE E F LOBBYING ACTIVITIES Approved by OMB <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1 352 0348-0046 <br /> See reverse for sublic burden disclosure. <br /> 'I.Type of Federal Action: 2. Status of Federal Action: . port Type: <br /> •a. contract a. bid/offer/application : .... a. initial filing <br /> .-b. grant • • b.initial award b. Material change <br /> c.cooperative reement post-award <br /> For Material Change Only: <br /> d_ loan year W quarter . <br /> a, loan guarantee date of last r� or# <br /> f. loan insurance _ --� <br /> 4. Name d Address f Reporting Entity: <br /> f Reporting Entity i�l l � is a a <br /> Li Prime ❑Subawardee and Address of Prime: <br /> Tier if known: <br /> OE COUNTY <br /> 200 SOUTH CAMERON STREET <br /> HILL E°ROU H,NC 27278 <br /> Con re5 Tonal District, if known: 0 Congressional District, if known: <br /> 6. Federal DepartmentlAgency: .7. Federal Program Name/Description: ` 1. <br /> RBCS BUSINESS ENTERPRISE GRANTS <br /> LFDA Number,.if applicable: 10.3 51 <br /> 8. Federal Action Number,if known: -19.Award Amount, if known <br /> .a_ Name and Address of Lobbying Entity <br /> 1To y . Individuals Performing Services address <br /> rr�rr' t last a ern , different from No. 10a) <br /> (last name, first name, MO: <br /> .� _ <br /> 11.Amount of Payment(check all that apply): 13.Type of Payment(check a//that apply): <br /> $ U actual ❑planned ❑a. retainer <br /> _ Db.one-timefee <br /> 1 , Form of Payment(check ail that apply) commission <br /> LI a.cash El d.contingent fee <br /> ❑b.in-kind;specify:nature ❑e.deferred <br /> value LI f.other;specify: <br /> 14.Brief Description of Services Performed or to be Performed and Date(s )of Service,including officer(s ),employee(s),or <br /> Member(s)contacted,for Payment indicated in Item 11: <br /> RECS ENTERPRISE TS <br /> attasfl. ondnua cn )#(s F-LU ,if neC <br /> 15.Continuaitin Shteiipi SF-LLLA attached: II Ye <br /> _ <br /> I 1 n orrr�aliorr requested throLF h Ibis fora,is authorized by ttti a 31 U.S.C_sedicn <br /> +13�2 This disela:�re cf k by�in�a fc:vdies Fs rn�t r1 al cepr seritatk n;f❑�open signature: <br /> which reliance was placed by the tier above when this transaction was made yr <br /> entered into This tsclosure is ragweed pursuant 10 31 IIS C.1352,This Print Name: <br /> �r�formatior�will be reported to the Congress semi-annually and Will be available for <br /> --^�- <br /> public rnspe,+Gttion a{Any person who fails to file the required disclosure shall be subject Title: <br /> to civil pe I.0�4 a not ��. .... rl ....• • <br /> P t less that 7 0,000.and not mare!harp 5100,000.for each such <br /> failure. Telephone No,: Date: <br /> L - o L•-��yyv g,�� - L ..�,may-���g„v_ ..g -� -� •r+L -r _ - <br /> :.V. !' Z'' •i #•rx�` ,igt L0,: .r `Y,JIj# s _V r' i i } n 'a g e }= 1 ;N , :55;:} }_ Out Ionze fa Lot Rep ucLron • <br /> 'yf�y}'��ry�v .�,�,y J � 'fir k�,r=K-M1 �ycy }�}w�ti;r';4��+���c ?��} � �y V',+�_4��� _4_�� �" __ � �-' . <br /> v � I �--rr� � �r rJl- �I} �C � �rr� �I} �r?f-'-'-J{+C4 ��r I} ��r �I} .�'_. �� �I�- � �'� <br /> L �.� INI M ll ,` `�'�.ig i�� {?, ... ,+ �` ` 4� �{ `Rii t Standard Form LLB.(Rev,7-97) <br />