NM Rep Lobbyist

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					                                                   State of New Mexico
                                              Office of the Secretary of State
                                                   Ethics Administration
                                                     325 Don Gaspar, Suite 300
                                                    Santa Fe, New Mexico 87503
                                                  (800) 477-3632 or (505) 827-3600

                                           2011 LOBBYIST REPORTING FORM
                                              Report of Expenditures & Contributions

FORM A - IDENTIFYING INFORMATION & FINANCIAL SUMMARY
REPORT DUE:      May 2, 2011
Filing as a:         Lobbyist                                         Lobbyist Employer
       Name of Lobbyist                                                     Telephone #                                 Fax #
 1a.

       Address                                                                  City                       State                 Zip
 b.

       Email Address
 c.

       If filing as a Lobbyist employer, the Employer's name                                                       Telephone #

 d.
       Employer's Address                                                       City                       State                 Zip


  2    FINANCIAL SUMMARY (Cumulative)
 a.                                    Total Meal and Beverage Expenses (from Form B1)            $              0.00
 b.                                  Total Other Entertainment Expenses (from Form B2)            $              0.00
 c.                                                     Total Gift Expenses (from Form B3)        $              0.00
 d.                                                   Total Other Expenses (from Form B4)         $              0.00
 e.                                            Total Special Event Expenses (from Form C)         $              0.00
 f.                                                                    TOTAL EXPENDITURES                                $             0.00
 g.                                      TOTAL POLITICAL CONTRIBUTIONS (from Form D)                                     $             0.00
I hereby swear of affirm under penalty of law that this statement is true, correct and complete to the best of my knowledge.


            (Signature of Lobbyist/Lobbyist Employer)

                                                     NOTARY INFORMATION
State of
County of

Subscribed and sworn to me this ________ day of _____________________, 20_______, by ____________________


                            (SEAL)
                                                                                           (Signature of notarial officer)

                                                                      My commission expires:
State of New Mexico
Lobbyist Regulation Act                                                                                                              2011

                                                                 Report of Expenditures
                                                              FORM B1
                                                      MEAL & BEVERAGE EXPENSES
   Name of Lobbyist or Lobbyist Employer:                                                                                                       0
                                    Itemize each Meal & Beverage expenditure in accordance with Section 2-11-6, NMSA 1978

   Date                   Name of Payee                     Name of Beneficiary                    Purpose for which made or       Amount
                                                      (i.e. Legislators, Staff, Committee, etc.)            incurred



                                                                                                                               $




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                                                                                                                               $




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                                                                                                      SUBTOTAL THIS PAGE       $            -
State of New Mexico
Lobbyist Regulation Act                                                                                                              2011

                                                                Report of Expenditures
                                                          FORM B1 - Cont'd
                                                     MEAL & BEVERAGE EXPENSES
  Name of Lobbyist or Lobbyist Employer:                                                                                                        0
                                   Itemize each Meal & Beverage expenditure in accordance with Section 2-11-6, NMSA 1978

   Date                   Name of Payee                     Name of Beneficiary                    Purpose for which made or       Amount
                                                      (i.e. Legislators, Staff, Committee, etc.)            incurred



                                                                                                                               $




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                                                                                                                               $




                                                                                                                               $




                                                                                                                               $




                                                                                                                               $




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                                                                                                                               $



                                                                                TOTAL MEAL & BEVERAGE EXPENSES $                            -
State of New Mexico
Lobbyist Regulation Act                                                                                                  2011

                                                     Report of Expenditures
                                                    FORM B2
                                             ENTERTAINMENT EXPENSES
  Name of Lobbyist or Lobbyist Employer:                                                                                            0
                          Itemize each Entertainment expenditure in accordance with Section 2-11-6, NMSA 1978

  Date                Name of Payee                   Name of Beneficiary                      Purpose for which       Amount
                                                  (i.e. Legislators, Staff, Committee, etc.)   made or incurred



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                                                                                   $



                                                           TOTAL ENTERTAINMENT EXPENSES                            $            -
State of New Mexico
Lobbyist Regulation Act                                                                                          2011

                                                    Report of Expenditures
                                                         FORM B3
                                                      GIFT EXPENSES
Name of Lobbyist or Lobbyist Employer:                                                                                      0
                              Itemize each gift expenditure in accordance with Section 2-11-6, NMSA 1978

   Date                   Name of Beneficiary                Purpose for which made or incurred                Amount


                                                                                                           $



                                                                                                           $



                                                                                                           $



                                                                                                           $



                                                                                                           $



                                                                                                           $



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                                                                                                           $



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                                                                                                           $



                                                                                                           $



                                                                               TOTAL GIFT EXPENSES $                    -
State of New Mexico
Lobbyist Regulation Act                                                                                                            2011

                                                              Report of Expenditures
                                                                 FORM B4
                                                              OTHER EXPENSES
Name of Lobbyist or Lobbyist Employer:                                                                                                        0
                                      Itemize each Other expenditure in accordance with Section 2-11-6, NMSA 1978

   Date                   Name of Payee                  Name of Beneficiary                     Purpose for which made or       Amount
                                                   (i.e. Legislators, Staff, Committee, etc.)             incurred




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




                                                                                                                             $




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                                                                                                                             $




                                                                                                TOTAL OTHER EXPENSES         $            -
State of New Mexico
Lobbyist Regulation Act                                                                                                 2011
                                                          Report of Expenditures
                                                                FORM C
                                                              SPECIAL EVENTS

   Name of Lobbyist or Lobbyist Employer:                                                                                              0


    Date                           Type of Event & Location                        Name of Group(s) Invited       Total Expenses




                                                                                                              $




                                                                                                              $




                                                                                                              $




                                                                                                              $




                                                                                                              $




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                                                                                                              $

                                                                              TOTAL SPECIAL EVENTS            $                    -
State of New Mexico
Lobbyist Regulation Act                                                                            2011
                                                      FORM D
                                         POLITICAL CONTRIBUTIONS

Name of Lobbyist or Lobbyist Employer:                                                                        0

   Date            Name of candidate, public official or ballot issue supported or opposed       Amount




                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $

                                                                     SUBTOTAL THIS PAGE $                 -
State of New Mexico
Lobbyist Regulation Act                                                                            2011
                                                  FORM D - Cont'd
                                         POLITICAL CONTRIBUTIONS
Name of Lobbyist or Lobbyist Employer:                                                                        0

   Date            Name of candidate, public official or ballot issue supported or opposed       Amount




                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $



                                                                                             $

                                                    TOTAL POLITICAL CONTRIBUTIONS $                       -
State of New Mexico
Lobbyist Regulation Act                                                                                   2011
                                                      FORM E
                                            BUNDLING DISCLOSURE
NOTE: If you, or any of your employers delivered, directly or indirectly, separate political contributions from other
contributors of five hundred dollars ($500.00) or more, in the aggregate, for an election to a candidate, a campaign
committee, or anyone authorized by a candidate to receive funds on his/her behalf, the law requires disclosure of the
names, addresses and occupations of the contributors.

Name of Lobbyist or Lobbyist Employer:                                                                                  0

Full name of contributor


Street Address or P.O. Box ; City, State & Zip


Occupation                                       Amount of each separate political contribution:

                                                                                                   $
Full name of contributor


Street Address or P.O. Box ; City, State & Zip


Occupation                                       Amount of each separate political contribution:

                                                                                                   $
Full name of contributor


Street Address or P.O. Box ; City, State & Zip




Full name of contributor


Street Address or P.O. Box ; City, State & Zip


Occupation                                       Amount of each separate political contribution:

                                                                                                   $

				
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