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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U . S . C . 1352 0348-0046 ( See reverse for public burden disclosure . ) 1 . Type of Federal Action : 2. Status of Federal Action : 3 . Report Type : [ b l a . contract ( b la . bid/offer/application f b 1 a . initial filing L J b . grant t Ia . initial award ` J 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. ff Reporting Entity in No . 4 is a Subawardee, Enter Name 0 Prime ❑ Subawardee and Address of Prime : Tier if known : . COUNTY DOES NOT ENGAGE IN LOBBYING ACTIVITY Congressional District , if known : Congressional District, if known : 6. Federal Department/Agency: 7 . Federal Program Name/Description : CFDA Number, if applicable : 8 . Federal Action Number, if known : 19, Award Amount, if known : 10 . a. Name and Address of Lobbying Registrant b. Individuals Performing Services ( including address if ( if individual, last name, first name, Ml ) : different from No. 10a ) ( last name, first name, M/ ) : NONE NONE 11 , Information requested through this form is authorized by tide 31 U.S.C_ section Signature : 1352. This disclosure of lobbying activities is a material representation of fact upon which . reliance was placed by the tier above when this transaction was made COMMISSIONER TOM LOWTHER or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Print Name : information will be available for public inspection. Any person who fails to file the INDIAN RIVER CO . BOARD OF COUNTY COMMISSIONERS required disclosure shall be subject to a civil penalty of not less than $10,000 and Title : not more than $100,0DO for each such failure. Telephone No . : 772-567-8000 Date: S / 3 J 2 n n 5 Federal Use Only: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)