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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 J a . contract ( a 1 a . bid/offer/application [ a ) a . initial filing l 1 b . grant l J b . 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. 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 11Information requested through this form is authorized 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 THOMAS LO WTHER, CHAIRMAN or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Print Name : 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 tea 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 Federal Use Only : Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)