Orange County NC Website
Browse       Search
<br />15. Continuation Sheet(s) SF-LLL-A attached: Yes No <br /> <br />16. Information requested through this form is authorized <br />by title 31 U. S. C. section 1352. This disclosure of <br />lobbying activities is a material representation of fact <br />upon which reliance was placed by the tier above <br />when this transaction was made or entered into. This <br />disclosure is required pursuant to 31 U. S. C. 1352. <br />This information will be reported to the Congress <br />semi-annually and will be available for public <br />inspection. Any person who fails to file the required <br />disclosure shall be subject to a civil penalty of not <br />less than $10,000 and not more than $100,000 for <br />each such failure. <br /> <br />Signature: <br /> <br />Print Name: <br /> <br />Title: <br />___________________________________________ <br />___ <br /> <br />Telephone No: Date: <br />Federal Use Only Authorized for Local Reproduction <br />Standard Form - LLL <br /> <br />DocuSign Envelope ID: 2BDD55A6-AB10-4CEE-BD64-A15242793F1F