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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 orae-ooas rStatus e for ublic burden disclosure . ) 1 . Type of Federal Action : Federal Action : 3 . Report Type: la . bidloffer/application ( bl a . initial filing b l a . contract J t J b. material change L 1 b . grant b , initial award c . post-award For Material Change Only : c . cooperative agreement p year quarter d . loan date of last report e . loan guarantee f. loan insurance 4. Name and Address of Reporting Entity : 5. ff Reporting Entity in No . 4 is a Subawardee, Enter Name [] Prime ❑ Subawardee and Address of Prime: Tier , if known : . COUNTY DOES NOT ENGAGE IN LOBBYING ACTIVITY Con ressional District , if known : Con ressional District , if known : �1111111 1111111111 111 111 1111 1111 111 1 11 1 1 1111111111 111 7 . Federal Program Name/Description : 6. Federal Department/Agency: CFDA Number, if applicable : 8 . Federal Action Number, if known : 9 . Award Amount, if known $ [NONE: e and Address of Lobbying Registrant b. Individuals Performing Services (including address if dividual, last name, first name, Ml ): different from No. 1Oa ) ( last name, first name, Ml ): NONE mationrequested thmugh the form is authorized by title 31 U.S.C. section Signature:2. This disclosure of lobbying acbvities is a material representation of factupn which reliance was placed by the tier above when this transaction was made Print Name: COMMISSIONER TOM LOWTHER or entered into. This disclosure is required pursuant to 31 U.S-C. 1352. This information will be available for public inspection. Any person who fails to file the Title: RIVER CO. BOARD OF COUNTY COMMISSIONERS required disclosure shall be subject to a civil penalty of not less than $10,000 and ? 0 0 5 not more than $100.000 for each such failure. Telephone No . : 772-567- 8000 Date: 5 Authorized for Local Reproduction Federal Use Only : Standard Form LLL (Rev. 7-97)