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22 <br /> 15. Continuation Sheet(s) SF-LLL-A attached: ❑ Yes ❑ No <br /> 16. Information requested through this form is authorized Signature: <br /> by title 31 U. S. C. section 1352. This disclosure of <br /> lobbying activities is a material representation of fact Print Name: <br /> upon which reliance was placed by the tier above <br /> when this transaction was made or entered into. This Title: <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 Telephone No: Date: <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 /> Federal Use Only WAuthorized for Local Reproduction <br /> Standard Form-LLL <br />