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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 1 a . contract ! a ] a . bid/offer/application f a 1 a . initial filing 1 b . grant l J b . initial award I 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 . If Reporting Entity in No. 4 is a Subawardee, Enter Name ❑ Prime ❑ Subawardee and Address of Prime : Tier if known : INDIAN RIVER CO . BOARD OF COUNTY COMMISSIONERS THIS ENTITY DOES NOT ENGAGE IN LOBBYING Congressional District, if known : Congressional District , if known : 15, 16 6 . Federal Department/Agency : 7 . Federal Program Name/Description : US DEPT. OF HUD CFDA Number, if applicable : 8 . Federal Action Number, if known : 9 . 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. 1Oa ) ( last name, first name, M/ ) : NONE dq 11Information requested through this forth is audarized by title 31 U.S. C. section . 1352. This disclosure of lobbying activities is a material representation of fact Signature : upon which reliance was placed by the tier above when this transaction was made print Name : THOMAS LOWTHER, CHAIRMAN or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for Chairman public inspection. Any person who fails to file the required disclosure shall be Title : subject to a civil penalty of not less that $10,000 and not more than $100,000 for each such failure. Telephone No . : 772 - 226 - 1490 Date : 5 / 17 / 2005 Authorized for Local Reproduction Federal Use Only : Standard Form LLL (Rev. 7-97)